Updated on 2025/06/09

Information

 

写真a

 
TANAKA YOSHIMASA
 
Organization
Kyushu University Hospital Department of Hepatology and Pancreatology Assistant Professor
School of Medicine Department of Medicine(Concurrent)
Title
Assistant Professor
Profile
排便は直腸平滑筋および肛門括約筋の協調運動により行われる。しかし、それらの障害により起こる便秘は、生活の質に影響を及ぼすとともに近年、循環器疾患と脳血管疾患のリスク要因となり、生存率とも相関することが報告されている。 直腸平滑筋や肛門括約筋の収縮・弛緩に関与する因子は、神経や平滑筋および腸内からの影響など複雑に絡み合っているが未だ不明な部分が多い。新たな便秘治療選択肢を創造するためにもモデル動物を用いた基礎実験からヒトサンプルを用いた臨床研究までの幅広い様々な実験的手法を用いることによって、上記の消化管疾患をさまざまな観点から病態解析を行っている。

Research Areas

  • Life Science / Gastroenterology

Research History

  • Kyushu University Kyushu University Hospital Department of Hepatology and Pancreatology  Assistant Professor 

    2020.1 - Present

Education

  • Kyushu University    

Research Interests・Research Keywords

  • Research theme: Gastrointestinal motility

    Keyword: Gastrointestinal motility

    Research period: 2019.10

Awards

  • 第24回日本神経消化器病学会 最優秀演題賞

    2022.9   日本神経消化器病学会   光遺伝学的手法による排便中枢の局在および役割の検討

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Papers

  • Feasibility of traction band-assisted endoscopic closure for mucosal defects after colorectal endoscopic submucosal dissection: a multicenter prospective single-arm pilot study.

    Esaki M, Maehara K, Sumida Y, Minoda Y, Homma H, Inada T, Shiotsuki K, Fukuda SI, Akiho H, Nakamura N, Suzuki Y, Bai X, Tanaka Y, Hata Y, Ogino H, Chinen T, Ihara E, Ogawa Y

    Endoscopy   2025.5   ISSN:0013-726X

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    Language:English  

    DOI: 10.1055/a-2591-7104

    PubMed

  • Importance of rectal over colon status in ulcerative colitis remission: the role of microinflammation and mucosal barrier dysfunction in relapse.

    Kei Nishioka, Haruei Ogino, Eikichi Ihara, Takatoshi Chinen, Yusuke Kimura, Mitsuru Esaki, Xiaopeng Bai, Yosuke Minoda, Yoshimasa Tanaka, Masafumi Wada, Yoshitaka Hata, Yoko M Ambrosini, Yoshihiro Ogawa

    Journal of gastroenterology   60 ( 4 )   416 - 429   2025.4   ISSN:0944-1174 eISSN:1435-5922

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

    BACKGROUND: Ulcerative colitis (UC) is a refractory inflammatory disease that affects the rectum and colon, with pivotal involvement of the rectal environment in relapse initiation. This study was conducted in two phases to examine the differences in gene expression between the rectum and colon and to identify relapse factors. METHODS: In ***Study 1, RNA sequencing was performed on biopsies from the colon and rectum of patients with active UC, those with remission UC, and controls. In Study 2, the mucosal impedance (MI) values reflecting mucosal barrier function and the mRNA expression of tight junction proteins and inflammatory cytokines were examined in 32 patients with remission UC and 22 controls. Relapse was monitored prospectively. RESULTS: In Study 1, comprehensive genetic analysis using RNA sequencing revealed distinct gene profiles in the rectum and sigmoid colon of patients with remission UC. The rectum of these patients exhibited an enriched immune response and apical junction phenotype with persistent upregulation of CLDN2 gene expression. In Study 2, even in patients with remission UC, the MI values in the rectum, but not in the sigmoid colon, were significantly decreased, whereas they were negatively correlated with CLDN2, IL-1β, and IL-6 expressions. CONCLUSION: The status of the rectum in patients with remission UC differs from that of the colon, with microinflammation and impaired mucosal barrier function, which are associated with the upregulation of CLDN2, playing a role in relapse.

    DOI: 10.1007/s00535-024-02199-4

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  • 特集 慢性便秘症の診療のポイント 4.慢性便秘症の病態

    伊原 栄吉, 田中 義将, 竹島 翼, 白 暁鵬, 蓑田 洋介, 荻野 治栄

    臨床消化器内科   40 ( 3 )   291 - 297   2025.2   ISSN:0911601X eISSN:24332488

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    Publisher:日本メディカルセンター  

    DOI: 10.19020/cg.0000003376

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  • Traction-assisted endoscopic ultrasound-guided fine-needle biopsy using the clip-with-thread method for small gastric subepithelial lesions: Randomized controlled trial (with video). International journal

    Yosuke Minoda, Yusuke Suzuki, Haruei Ogino, Shuzaburo Nagatomo, Xiaopeng Bai, Mitsuru Esaki, Masafumi Wada, Yoshimasa Tanaka, Yoshitaka Hata, Nao Fujimori, Shinya Umekita, Daisuke Tsurumaru, Mitsuhiko Ota, Eiji Oki, Eikichi Ihara, Yoshihiro Ogawa

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   37 ( 5 )   512 - 520   2025.1   ISSN:0915-5635

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

    OBJECTIVES: Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is the gold standard for diagnosing gastric subepithelial lesions (SELs), but diagnosing lesions smaller than 20 mm remains challenging. We developed traction-assisted EUS-FNB (TA-EUS-FNB) using the clip-with-thread method to enhance diagnostic accuracy by stabilizing the lesion and providing counter-traction for easier needle access. This study evaluates the effectiveness of TA-EUS-FNB in diagnosing small gastric SELs. METHODS: In this prospective, randomized, controlled cross-over trial (August 2019-November 2022), 30 patients with gastric SELs <20 mm were randomized to undergo TA-EUS-FNB or conventional EUS-FNB. Each patient underwent four punctures, two per method. The primary end-point was the adequate tissue sampling rate for both techniques. Secondary end-points included diagnostic yield and performance (sensitivity and specificity) in distinguishing gastrointestinal stromal tumors (GISTs) from non-GISTs. RESULTS: The mean tumor size was 15.0 mm, with diagnoses comprising GISTs (n = 15, 50%), leiomyomas (n = 8, 26.7%), schwannomas (n = 2, 6.7%), aberrant pancreas (n = 3, 10%), and inflammation (n = 2, 6.7%). TA-EUS-FNB demonstrated a significantly higher adequate-tissue sampling rate (90% vs. 66.7%, P = 0.035) and diagnostic yield (86.7% vs. 63.3%, P = 0.037) than conventional EUS-FNB. Sensitivity (86.7%, 95% confidence interval [CI] 62.1-96.3% vs. 66.7%, 95% CI 41.7-84.8%; P = 0.20) and specificity (100%, 95% CI 79.6-100% vs. 100%, 95% CI 79.6-100%) were comparable between the methods. No adverse events were observed in the study. CONCLUSION: TA-EUS-FNB demonstrated superior tissue sampling rates and diagnostic yield for SELs <20 mm compared to conventional EUS-FNB, making it a viable option. Controlling lesion mobility is essential for successful EUS-FNB in small SELs.

    DOI: 10.1111/den.14977

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  • 特集 薬剤師の情報福袋 新薬,診療GL,etc詰め合わせ Pick Up! 注目の診療ガイドライン③ 新薬続々,便通異常症 診療ガイドライン2023 ─機能性便秘症と機能性下痢症─

    荻野 治栄, 田中 義将, 伊原 栄吉

    薬局   76 ( 1 )   36 - 40   2025.1   ISSN:00440035

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    Publisher:南山堂  

    DOI: 10.15104/ph.2025010009

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  • Spray and forced coagulation mode endoscopic submucosal dissection for early gastric neoplasms: a multicenter randomized controlled trial

    Esaki M., Sumida Y., Maehara K., Yamaguchi D., Nishioka K., Homma H., Inada T., Shiotsuki K., Fukuda S.I., Akiho H., Nomura T., Mizuta Y., Ishida S., Fujimoto S., Kimura S., Tanaka Y., Hata K., Shiga N., Iwasa T., Kimura Y., Nakamura N., Suzuki Y., Minoda Y., Bai X., Tanaka Y., Hata Y., Ogino H., Chinen T., Ihara E., Tagawa K., Ogawa Y.

    American Journal of Gastroenterology   2025   ISSN:00029270

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    Language:English   Publisher:American Journal of Gastroenterology  

    Objectives: Controlling intraoperative bleeding during endoscopic submucosal dissection (ESD) is essential to ensure the safety and reliability of the procedure. ESD in spray coagulation mode (SCM-ESD) is expected to ensure more effective bleeding control. This study aimed to investigate the superiority of SCM-ESD over conventional forced coagulation mode ESD (FCM-ESD) in terms of hemostatic ability for treating early gastric neoplasms (EGNs).Methods:This multicenter randomized controlled trial (Spray-G Trial) was conducted at five Japanese institutions. Patients with intramucosal EGNs were enrolled and randomly assigned to either the SCM-ESD or FCM-ESD group. The primary outcome was ESD completion with an electrosurgical knife alone, that is, without the use of hemostatic forceps. The number and duration of hemostatic procedures using hemostatic forceps, procedure time, curability, and adverse events were also evaluated.Results:Each group included 65 patients. The rate of ESD completion without using hemostatic forceps was significantly higher for SCM-ESD than for FCM-ESD (83.1% vs. 13.8%, p<0.0001). SCM-ESD and FCM-ESD did not differ significantly in terms of procedure time (48.3 min vs. 56.0 min, p=0.1071), R0 resection (100% vs. 95.4%, p=0.2442), and rate of adverse events (3.1% vs. 6.2%, p=0.6801).Conclusions:SCM-ESD significantly improved ESD completion rates for intramucosal EGNs without using hemostatic forceps. SCM-ESD is a promising technique that may streamline ESD by eliminating the need to exchange devices and reducing costs.

    DOI: 10.14309/ajg.0000000000003360

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  • 診療ガイドラインat a glance 便通異常症診療ガイドライン2023(慢性便秘症・慢性下痢症)

    伊原 栄吉, 田中 義将, 荻野 治栄

    日本内科学会雑誌   113 ( 10 )   1948 - 1954   2024.10   ISSN:0021-5384 eISSN:1883-2083

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

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  • 今月の主題 食道運動障害の診断と治療 トピックス 食道運動障害の病態評価に対する新たな試み

    水流 大尭, 牟田 和正, 和田 将史, 畑 佳孝, 蓑田 洋介, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    胃と腸   59 ( 9 )   1273 - 1278   2024.9   ISSN:05362180 eISSN:18821219

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    Publisher:株式会社医学書院  

    DOI: 10.11477/mf.1403203718

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  • 今月の主題 食道運動障害の診断と治療 主題 食道運動障害のX線診断

    畑 佳孝, 水流 大尭, 和田 将史, 蓑田 洋介, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    胃と腸   59 ( 9 )   1219 - 1228   2024.9   ISSN:05362180 eISSN:18821219

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    Publisher:株式会社医学書院  

    DOI: 10.11477/mf.1403203711

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  • 特集 今この研究が面白い! 第6章 消化管 [便秘]腸内細菌と腸管運動機能

    白 暁鵬, 田中 義将, 伊原 栄吉

    内科   134 ( 3 )   603 - 606   2024.9   ISSN:00221961 eISSN:24329452

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    Publisher:南江堂  

    DOI: 10.15106/j_naika134_603

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  • Protective role of M3 muscarinic acetylcholine receptor in indomethacin-induced small intestinal injury. International journal

    Yoko Igarashi-Hisayoshi, Eikichi Ihara, Xiaopeng Bai, Yoshimasa Tanaka, Haruei Ogino, Takatoshi Chinen, Yasushi Taguchi, Yoshihiro Ogawa

    Journal of molecular medicine (Berlin, Germany)   102 ( 9 )   1175 - 1186   2024.9   ISSN:0946-2716 eISSN:1432-1440

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Journal of Molecular Medicine  

    EP4 prostanoid receptor (EP4R) contributes to the intestinal epithelial Cl- secretion, and inhibition of prostaglandin E (PGE) production by non-steroidal anti-inflammatory drugs (NSAIDs) plays a central role in NSAID-induced enteropathy. Although M3 muscarinic acetylcholine receptor (M3R) also contributes to the intestinal epithelial Cl- secretion, it remains unclear whether M3R is involved in NSAID-induced enteropathy due to a lack of selective agents. The present study explored how M3R is involved in the regulation of the intestinal epithelial Cl- secretion and its pathophysiological role in NSAID-induced enteropathy. Using the novel highly-selective M3 positive allosteric modulator PAM-369 that we recently developed, we evaluated the role of M3R in the intestinal epithelial secretion ex vivo by measuring the short circuit current (Isc) of intestinal epithelium with a Ussing chamber system and examined whether or not M3R protects against small intestinal injury in indomethacin-treated mice. Both the PGE1 derivative misoprostol and carbachol similarly increased the Isc in a concentration-dependent manner. The Isc increases were abolished either by receptor antagonists (an EP4R antagonist and a M3R antagonist, respectively) or by removal of extracellular Cl-. PAM-369 enhanced the carbachol-induced Isc by potentiating M3R, which could contribute to enhanced intestinal epithelial secretion. Treatment with PAM-369 ameliorated small intestinal injury in indomethacin-treated mice. Importantly, the M3R expression was significantly up-regulated, and PAM-369 potentiation of M3R was augmented in indomethacin-treated mice compared to untreated mice. These findings show that M3R plays a role in maintaining the intestinal epithelial secretion, which could contribute to protection against indomethacin-induced small intestinal injury. M3R is a promising target for treating or preventing NSAID-induced enteropathy. KEY MESSAGES: PAM-369, the M3 positive allosteric modulator, was used to potentiate M3R. PAM-369 enhanced carbachol-induced Isc in mouse ileum. PAM-369 ameliorated small intestinal injury in indomethacin-treated mice. M3R is a promising target for treating or preventing NSAID-induced enteropathy.

    DOI: 10.1007/s00109-024-02474-0

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  • Development and Validation of a Simple and Multifaceted Instrument, Chronic Constipation-Therapeutic Efficacy and Satisfaction Test, for the Clinical Evaluation of Patients with Chronic Constipation

    Nakada, K; Nagahara, A; Isshi, K; Oshima, T; Futagami, S; Tanaka, Y; Yamaguchi, Y; Kuribayashi, S; Arihiro, S; Oshio, A; Manabe, N

    DIGESTION   105 ( 5 )   359 - 372   2024.9   ISSN:0012-2823 eISSN:1421-9867

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    Language:English   Publisher:Digestion  

    Introduction: This study evaluated the psychometric properties of the newly developed chronic constipationtherapeutic efficacy and satisfaction test (CC-TEST) among patients with chronic constipation. Methods: Japanese patients with moderate or severe chronic constipation underwent a 4-week remedy. The baseline, 2-week, and 4-week assessments included the CC-TEST, Constipation Scoring System (CSS), Medical Outcome Study Short Form-8 Health Survey (SF-8), and Hospital Anxiety and Depression Scale (HADS). The CC-TEST comprises three domains: (1) symptoms; chronic constipation symptom severity (seven items), defecation status (five items), (2) impact for daily life; dissatisfaction with daily life level (DS; four items), and (3) therapeutic response; therapeutic efficacy measured by patients and medication compliance (four items). Results: Of 201 eligible patients at baseline, 110 completed the 4-week treatment and the survey responses. Cronbach's a values for the stool, defecation, and abdominal symptom subscales, as well as the total symptom score and DS subscale, showed good internal consistency reliability (0.72-0.80). Pearson's r for comparisons between corresponding items (CC-TEST symptoms with CSS, and CC-TEST DS with SF-8 physical and mental component summary scores) was significant. After 4 weeks, scores for symptoms, defecation status, and DS items/subscales notably decreased, with a significant effect size (p < 0.005, Cohen's d; 0.30-1.16). Statistically significant differences emerged between treatment responders and nonresponders using the three responder definitions, in changes in scores for most CC-TEST symptoms, defecation status, and DS items/subscales (p < 0.05). Conclusion: CCTEST demonstrates commendable reliability, convergent and known-group validity, and responsiveness to treatment effects. As a simple, comprehensive, and versatile patientreported outcome measure, CC-TEST may be well suited for clinical trials and primary care of Japanese patients with chronic constipation.

    DOI: 10.1159/000539788

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  • 【今この研究が面白い!】(第6章)消化管 便秘 腸内細菌と腸管運動機能 a role of microbes in gut motility

    白 暁鵬, 田中 義将, 伊原 栄吉

    内科   134 ( 3 )   603 - 606   2024.9   ISSN:0022-1961 eISSN:2432-9452

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    Language:Japanese   Publisher:(株)南江堂  

    <文献概要>・われわれは慢性便秘症の病態解明と新規治療法の開発を目指し,腸内細菌が腸管運動機能に及ぼす影響とその機序について基礎およびトランスレーショナル研究を行っている.・単一菌種を定着させたノトバイオート動物モデルを用いて,腸内細菌が宿主自然免疫反応を介し,小腸筋間神経叢の血管作動性腸管ペプチド(VIP)神経の発現調節が腸管運動機能の発達・維持に重要な役割を果たすことを解明した.・慢性便秘症患者より採取した糞便を移植して作製したマウスモデルを解析したところ,慢性便秘症患者から採取した腸内細菌が大腸筋間神経叢に炎症性マクロファージを増加させ,Cajal介在細胞(ICC)のネットワーク障害をきたし,大腸運動低下に至る経路を見出した.

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    Other Link: https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J00974&link_issn=&doc_id=20240830040062&doc_link_id=10.15106%2Fj_naika134_603&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_naika134_603&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

  • 【食道運動障害の診断と治療】食道運動障害のX線診断

    畑 佳孝, 水流 大尭, 和田 将史, 蓑田 洋介, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    胃と腸   59 ( 9 )   1219 - 1228   2024.9   ISSN:0536-2180 eISSN:1882-1219

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    <文献概要>●高解像度食道内圧検査(HRM)の開発と食道運動障害の国際分類であるシカゴ分類が提唱されたことで,食道運動障害(EMD)の診療が飛躍的に発展した.EMD診断のゴールドスタンダードはHRMとなったが,いまだ検査可能な施設は限られており,日常診療におけるEMDの拾い上げ検査として食道X線造影検査にかかる期待は大きい.本稿では古典的食道X線所見(正常,数珠様・コークスクリュー様,無蠕動・微弱蠕動)に加えて,筆者らが新規に提唱する波様,下部食道バルーニングも含めた各食道X線所見について解説した.これらの食道X線所見を用いることで,EMDの拾い上げに対する食道X線造影検査の感度(79.4%)と特異度(88%)は満足な結果であった.食道X線造影検査のみでHRMに基づくEMDの確定診断を行うことは困難であるが,日常診療におけるEMD拾い上げ検査としては,食道X線造影検査は有用な検査として位置付けられる.

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  • 【食道運動障害の診断と治療】食道運動障害の病態評価に対する新たな試み

    水流 大尭, 牟田 和正, 和田 将史, 畑 佳孝, 蓑田 洋介, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    胃と腸   59 ( 9 )   1273 - 1278   2024.9   ISSN:0536-2180 eISSN:1882-1219

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    Language:Japanese   Publisher:(株)医学書院  

    <文献概要>はじめに 上部食道括約筋(upper esophageal sphincter;UES)から下部食道括約筋(lower esophageal sphincter;LES)の食道運動をリアルタイムに可視化する高解像度食道内圧検査(high-resolution manometry;HRM)の登場とその診断基準であるシカゴ分類の確立によって,食道運動の機能評価法は発展を遂げた.しかし,HRMとシカゴ分類では評価困難な食道運動障害(esophageal motility disorders;EMDs)が存在し,その原因として注目されるのが食道伸展性(拡張性)と伸展刺激で誘発される二次蠕動である.本稿では食道伸展性の評価法と二次蠕動に注目し解説する.

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  • 光遺伝学および化学遺伝学的手法を用いた脳排便中枢の解析

    田中 義将, 佛坂 孝太, 伊原 栄吉

    潰瘍   51   66 - 66   2024.9   ISSN:2189-7956

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    Language:Japanese   Publisher:(一社)日本潰瘍学会  

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  • 十二指腸胃食道逆流症の診断のためのビリルビンを可視化する新規内視鏡の開発(Development of a new endoscopy system to visualize bilirubin for the diagnosis of duodenogastroesophageal reflux)

    Wada Masafumi, Minoda Yosuke, Ihara Eikichi, Tsuru Hirotaka, Hata Yoshitaka, Nagatomo Shuzaburo, Esaki Mitsuru, Bai Xiaopeng, Tanaka Yoshimasa, Chinen Takatoshi, Ogino Haruei, Ogawa Yoshihiro

    Digestive Endoscopy   36 ( 8 )   904 - 914   2024.8   ISSN:0915-5635

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    Language:English   Publisher:John Wiley & Sons Australia, Ltd  

    逆流過敏(RH)は胃食道逆流性疾患の一種であり、十二指腸胃食道逆流(DGER)が関与している。本研究の目的は、DGERおよびRH評価のための画像強調技術を装備した内視鏡システムの有用性を明らかにすることである。ビリルビンを同定する画像強調観察モードをBilモード、計算値をBil値と定義した。まず、Bilモードの可視性を、胆汁濃度0.01%から100%(0.002~20mg/dL)の液体を用いて検証した。次いで、ビリルビン溶液を豚食道に散布して、Bilモードの視認性スコアをブルーレーザーイメージング(BLI)および白色光イメージング(WLI)モードと比較した。その後、多チャンネル壁内インピーダンス-pHモニタリングを用いて食道Bil値と非酸性逆流イベント(NNRE)の相関について検討し、またRHの鑑別診断における食道Bil値の有用性を明らかにした。ビリルビン濃度が1%を超えるビリルビン溶液は、Bilモードで赤色に可視化された。1%から6%のビリルビン溶液に対しては、Bilモードを用いた場合の視認性スコアはBLIおよびWLIモードと比較して有意に高かった(P<0.05)。食道Bil値とNNREとの間には有意な正の相関が認められた(P=0.031)。RHの鑑別診断に対する受容者動作特性曲線下面積は0.817であった。以上より、Bilモードは正確にビリルビンを同定し、実臨床でDGERの評価に使用できる可能性が示された。

  • GERDに対する治療選択とアウトカム 難治性胃食道逆流症に対するボノプラザンと内視鏡的逆流防止粘膜切除術の有用性の検討

    畑 佳孝, 水流 大尭, 和田 将史, 牟田 和正, 蓑田 洋介, 江崎 充, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本食道学会学術集会プログラム・抄録集   78回   39 - 39   2024.7

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  • アカラシアにおけるTh17免疫反応と関連した食道細菌叢の変化とLC20不全リン酸化の相互作用(The interplay between alterations in esophageal microbiota associated with Th17 immune response and impaired LC20 phosphorylation in achalasia)

    Ikeda Hiroko, Ihara Eikichi, Takeya Kosuke, Mukai Koji, Onimaru Manabu, Ouchida Kenoki, Hata Yoshitaka, Bai Xiaopeng, Tanaka Yoshimasa, Sasaki Taisuke, Saito Fumiyo, Eto Masumi, Nakayama Jiro, Oda Yoshinao, Nakamura Masafumi, Inoue Haruhiro, Ogawa Yoshihiro

    Journal of Gastroenterology   59 ( 5 )   361 - 375   2024.5   ISSN:0944-1174

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    食道平滑筋収縮の変化および関連する炎症性反応について検討することによりアカラシアの病態を明らかにし、アカラシアの進展における食道細菌叢の意義を評価した。経口的内視鏡的筋層切開術を施行したII型アカラシア症例から得た食道粘膜および下部食道括約筋(LES)標本を解析した。患者由来の食道調整培養液をマウス食道に投与し、食道内環境がアカラシアと関連するか否かについて検討した。安静時および刺激時における対照群のLESでは、20-kDaミオシン軽鎖(LC20)の約30%がリン酸化されていた。アカラシア症例では状況に関わらずLC20のリン酸化は10%未満であった。アカラシアにおける低リン酸化は、ミオシンリン酸化阻害蛋白質CPI-17の発現低下と関連していた。IL-17A、IL-17F、IL-22、IL-23Aを含む関連サイトカインは、アカラシアでは発現が増加していた。食道細菌叢のα-Diversity指数、およびActinomycesおよびDialisterを含む数種類の細菌の割合がアカラシアで増加していた。ActinomycesレベルはIL-23Aレベルと正の相関が認められ、DialisterレベルはIL-17A、IL-17F、IL-22レベルと正の相関が認められた。マウスにおいて、食道IL-17F値は調整培地の経口投与後に増加した。

  • The interplay between alterations in esophageal microbiota associated with Th17 immune response and impaired LC20 phosphorylation in achalasia.

    Hiroko Ikeda, Eikichi Ihara, Kosuke Takeya, Koji Mukai, Manabu Onimaru, Kenoki Ouchida, Yoshitaka Hata, Xiaopeng Bai, Yoshimasa Tanaka, Taisuke Sasaki, Fumiyo Saito, Masumi Eto, Jiro Nakayama, Yoshinao Oda, Masafumi Nakamura, Haruhiro Inoue, Yoshihiro Ogawa

    Journal of gastroenterology   59 ( 5 )   361 - 375   2024.3   ISSN:0944-1174 eISSN:1435-5922

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    BACKGROUND: Achalasia is an esophageal motility disorder with an unknown etiology. We aimed to determine the pathogenesis of achalasia by studying alterations in esophageal smooth muscle contraction and the associated inflammatory response, and evaluate the role of esophageal microbiota in achalasia development. METHODS: We analyzed esophageal mucosa and lower esophageal sphincter (LES) samples, obtained from patients with type II achalasia who underwent peroral endoscopic myotomy. Esophageal conditioned media obtained from patients were transferred into the mouse esophagus to determine whether the esophageal intraluminal environment is associated with achalasia. RESULTS: Approximately 30% of 20-kDa myosin light chains (LC20) was phosphorylated in LES from the control group under resting and stimulated conditions, whereas less than 10% of LC20 phosphorylation was detected in achalasia under all conditions. The hypophosphorylation of LC20 in achalasia was associated with the downregulation of the myosin phosphatase-inhibitor protein CPI-17. Th17-related cytokines, including IL-17A, IL-17F, IL-22, and IL-23A, were significantly upregulated in achalasia. α-Diversity index of esophageal microbiota and the proportion of several microbes, including Actinomyces and Dialister, increased in achalasia. Actinomyces levels positively correlated with IL-23A levels, whereas Dialister levels were positively associated with IL-17A, IL-17F, and IL-22 levels. Esophageal IL-17F levels increased in mice after oral administration of the conditioned media. CONCLUSIONS: In LES of patients with achalasia, hypophosphorylation of LC20, a possible cause of impaired contractility, was associated with CPI-17 downregulation and an increased Th17-related immune response. The esophageal intraluminal environment, represented by the esophageal microbiota, could be associated with the development and exacerbation of achalasia.

    DOI: 10.1007/s00535-024-02088-w

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  • 当院における高齢者ボノプラザン抵抗性胃食道逆流症の病態の特徴

    水流 大尭, 和田 将史, 畑 佳孝, 牟田 和正, 蓑田 洋介, 江崎 充, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本高齢消化器病学会誌   26 ( 2 )   19 - 24   2024.3   ISSN:1881-0837

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    胃食道逆流症(GERD)は病的な酸逆流によって惹起される病態であるが、難治性GERDでは食道知覚過敏や食道運動異常症(EMDs)を考慮した病態評価が必要である。今回、高齢者ボノプラザン(P-CAB)抵抗性GERDの特徴を明らかにするため、75歳以上の高齢者20例と非高齢者51例の食道生理機能検査の結果を比較検討した。高解像度食道内圧検査では非高齢者の41%は正常であったが、高齢者では正常例は認めなかった。食道内多チャンネルインピーダンス・pHモニタリング検査では、非高齢者ではNERD、逆流過敏性食道、機能性胸焼けの3疾患を認めたが、高齢者では逆流過敏性食道は認めなかった。高齢者P-CAB抵抗性GERDでは、EMDsが目立ち食道知覚過敏の影響は小さい可能性がある。(著者抄録)

  • 当院における高齢者ボノプラザン抵抗性胃食道逆流症の病態の特徴

    水流 大尭, 和田 将史, 畑 佳孝, 牟田 和正, 蓑田 洋介, 江崎 充, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本高齢消化器病学会誌   26 ( 2 )   19 - 24   2024.3   ISSN:1881-0837

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    胃食道逆流症(GERD)は病的な酸逆流によって惹起される病態であるが、難治性GERDでは食道知覚過敏や食道運動異常症(EMDs)を考慮した病態評価が必要である。今回、高齢者ボノプラザン(P-CAB)抵抗性GERDの特徴を明らかにするため、75歳以上の高齢者20例と非高齢者51例の食道生理機能検査の結果を比較検討した。高解像度食道内圧検査では非高齢者の41%は正常であったが、高齢者では正常例は認めなかった。食道内多チャンネルインピーダンス・pHモニタリング検査では、非高齢者ではNERD、逆流過敏性食道、機能性胸焼けの3疾患を認めたが、高齢者では逆流過敏性食道は認めなかった。高齢者P-CAB抵抗性GERDでは、EMDsが目立ち食道知覚過敏の影響は小さい可能性がある。(著者抄録)

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  • 当院における高齢者ボノプラザン抵抗性胃食道逆流症の病態の特徴

    水流 大尭, 和田 将史, 畑 佳孝, 牟田 和正, 蓑田 洋介, 江崎 充, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本高齢消化器病学会誌   26 ( 2 )   19 - 24   2024.3   ISSN:1881-0837

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    胃食道逆流症(GERD)は病的な酸逆流によって惹起される病態であるが、難治性GERDでは食道知覚過敏や食道運動異常症(EMDs)を考慮した病態評価が必要である。今回、高齢者ボノプラザン(P-CAB)抵抗性GERDの特徴を明らかにするため、75歳以上の高齢者20例と非高齢者51例の食道生理機能検査の結果を比較検討した。高解像度食道内圧検査では非高齢者の41%は正常であったが、高齢者では正常例は認めなかった。食道内多チャンネルインピーダンス・pHモニタリング検査では、非高齢者ではNERD、逆流過敏性食道、機能性胸焼けの3疾患を認めたが、高齢者では逆流過敏性食道は認めなかった。高齢者P-CAB抵抗性GERDでは、EMDsが目立ち食道知覚過敏の影響は小さい可能性がある。(著者抄録)

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  • 機能性消化器疾患の病態解明と臨床展開 Distension-contraction plot法を用いた機能性嚥下障害の病態解明

    水流 大尭, 畑 佳孝, 和田 将史, 牟田 和正, 蓑田 洋介, 江崎 充, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本消化器病学会雑誌   121 ( 臨増総会 )   A130 - A130   2024.3   ISSN:0446-6586 eISSN:1349-7693

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  • 光遺伝学および化学遺伝学的手法を用いた脳排便中枢の解析

    田中 義将, 佛坂 孝太, 伊原 栄吉

    日本消化管学会雑誌   8 ( Suppl. )   157 - 157   2024.1   ISSN:2433-3840 eISSN:2435-8967

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  • Development of a new endoscopy system to visualize bilirubin for the diagnosis of duodenogastroesophageal reflux. International journal

    Masafumi Wada, Yosuke Minoda, Eikichi Ihara, Hirotaka Tsuru, Yoshitaka Hata, Shuzaburo Nagatomo, Mitsuru Esaki, Xiaopeng Bai, Yoshimasa Tanaka, Takatoshi Chinen, Haruei Ogino, Yoshihiro Ogawa

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   36 ( 8 )   904 - 914   2023.12   ISSN:0915-5635 eISSN:1443-1661

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    OBJECTIVES: Reflux hypersensitivity (RH) is a form of refractory gastroesophageal reflux disease in which duodenogastroesophageal reflux (DGER) plays a role. This study aimed to determine the usefulness of an endoscopy system equipped with image-enhanced technology for evaluating DGER and RH. METHODS: The image enhancement mode for detecting bilirubin and calculated values were defined as the Bil mode and Bil value, respectively. First, the visibility of the Bil mode was validated for a bilirubin solution and bile concentrations ranging from 0.01% to 100% (0.002-20 mg/dL). Second, visibility scores of the Bil mode, when applied to the porcine esophagus sprayed with a bilirubin solution, were compared to those of the blue laser imaging (BLI) and white light imaging (WLI) modes. Third, a clinical study was conducted to determine the correlations between esophageal Bil values and the number of nonacid reflux events (NNRE) during multichannel intraluminal impedance-pH monitoring as well as the utility of esophageal Bil values for the differential diagnosis of RH. RESULTS: Bilirubin solution and bile concentrations higher than 1% were visualized in red using the Bil mode. The visibility score was significantly higher with the Bil mode than with the BLI and WLI modes for 1% to 6% bilirubin solutions (P < 0.05). The esophageal Bil value and NNRE were significantly positively correlated (P = 0.031). The area under the receiver operating characteristic curve for the differential diagnosis of RH was 0.817. CONCLUSION: The Bil mode can detect bilirubin with high accuracy and could be used to evaluate DGER in clinical practice.

    DOI: 10.1111/den.14749

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  • 機能性消化管疾患の病態解明と臨床応用 光遺伝学および化学遺伝学的手法を用いた排便機構の解明

    田中 義将, 佛坂 孝太, 伊原 栄吉

    日本消化器病学会雑誌   120 ( 臨増大会 )   A568 - A568   2023.10   ISSN:0446-6586 eISSN:1349-7693

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  • 特集 GERD診療Update 2023 11.食道運動機能障害に起因するGERDと関連諸疾患の鑑別

    畑 佳孝, 和田 将史, 水流 大尭, 田中 義将, 荻野 治栄, 伊原 栄吉

    臨床消化器内科   38 ( 9 )   1201 - 1209   2023.7   ISSN:0911601X eISSN:24332488

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    DOI: 10.19020/cg.0000002753

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  • 「高齢者に多いGERDと便秘症の病態・診断・治療(性差も含めて)」 当院における高齢者の難治性胃食道逆流症の特徴とボノプラザンが与える影響

    水流 大尭, 和田 将史, 畑 佳孝, 牟田 和正, 蓑田 洋介, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本高齢消化器病学会誌   26 ( 1 )   49 - 49   2023.7

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  • 【GERD診療Update 2023】食道運動機能障害に起因するGERDと関連諸疾患の鑑別

    畑 佳孝, 和田 将史, 水流 大尭, 田中 義将, 荻野 治栄, 伊原 栄吉

    臨床消化器内科   38 ( 9 )   1201 - 1209   2023.7

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    <文献概要>胃食道逆流症(GERD)は「胃内容物の逆流により,不快な症状あるいは合併症を生じた状態」と定義される.日常診療で遭遇する,症状のみで食道粘膜傷害のない非びらん性逆流症(NERD)には,GERD以外の病態が紛れ込む.NERDと鑑別すべき重要な病態に食道運動機能障害(EMDs)があるが,EMDsの一つである無蠕動は高頻度にGERDを合併するため,疾患の理解を複雑化させている.最近,食道生理機能検査の発展に基づいてGERDの病態,鑑別疾患の理解が飛躍的に進歩した.本稿では,EMDsに起因するGERDと鑑別すべき関連諸疾患について概説する.治療抵抗性GERDに遭遇した際には食道生理機能検査を行い,機能性食道疾患,食道運動機能障害,行動障害などの鑑別を行うことが重要である.

  • 「高齢者に多いGERDと便秘症の病態・診断・治療(性差も含めて)」 当院における高齢者の難治性胃食道逆流症の特徴とボノプラザンが与える影響

    水流 大尭, 和田 将史, 畑 佳孝, 牟田 和正, 蓑田 洋介, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本高齢消化器病学会誌   26 ( 1 )   49 - 49   2023.7   ISSN:1881-0837

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  • 【GERD診療Update 2023】食道運動機能障害に起因するGERDと関連諸疾患の鑑別

    畑 佳孝, 和田 将史, 水流 大尭, 田中 義将, 荻野 治栄, 伊原 栄吉

    臨床消化器内科   38 ( 9 )   1201 - 1209   2023.7   ISSN:0911-601X eISSN:2433-2488

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    <文献概要>胃食道逆流症(GERD)は「胃内容物の逆流により,不快な症状あるいは合併症を生じた状態」と定義される.日常診療で遭遇する,症状のみで食道粘膜傷害のない非びらん性逆流症(NERD)には,GERD以外の病態が紛れ込む.NERDと鑑別すべき重要な病態に食道運動機能障害(EMDs)があるが,EMDsの一つである無蠕動は高頻度にGERDを合併するため,疾患の理解を複雑化させている.最近,食道生理機能検査の発展に基づいてGERDの病態,鑑別疾患の理解が飛躍的に進歩した.本稿では,EMDsに起因するGERDと鑑別すべき関連諸疾患について概説する.治療抵抗性GERDに遭遇した際には食道生理機能検査を行い,機能性食道疾患,食道運動機能障害,行動障害などの鑑別を行うことが重要である.

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  • 「高齢者に多いGERDと便秘症の病態・診断・治療(性差も含めて)」 当院における高齢者の難治性胃食道逆流症の特徴とボノプラザンが与える影響

    水流 大尭, 和田 将史, 畑 佳孝, 牟田 和正, 蓑田 洋介, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本高齢消化器病学会誌   26 ( 1 )   49 - 49   2023.7   ISSN:1881-0837

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  • 【GERD診療Update 2023】食道運動機能障害に起因するGERDと関連諸疾患の鑑別

    畑 佳孝, 和田 将史, 水流 大尭, 田中 義将, 荻野 治栄, 伊原 栄吉

    臨床消化器内科   38 ( 9 )   1201 - 1209   2023.7   ISSN:0911-601X eISSN:2433-2488

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    <文献概要>胃食道逆流症(GERD)は「胃内容物の逆流により,不快な症状あるいは合併症を生じた状態」と定義される.日常診療で遭遇する,症状のみで食道粘膜傷害のない非びらん性逆流症(NERD)には,GERD以外の病態が紛れ込む.NERDと鑑別すべき重要な病態に食道運動機能障害(EMDs)があるが,EMDsの一つである無蠕動は高頻度にGERDを合併するため,疾患の理解を複雑化させている.最近,食道生理機能検査の発展に基づいてGERDの病態,鑑別疾患の理解が飛躍的に進歩した.本稿では,EMDsに起因するGERDと鑑別すべき関連諸疾患について概説する.治療抵抗性GERDに遭遇した際には食道生理機能検査を行い,機能性食道疾患,食道運動機能障害,行動障害などの鑑別を行うことが重要である.

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  • 難治性逆流性食道炎と無蠕動を合併した1例

    畑 佳孝, 水流 大尭, 和田 将史, 牟田 和正, 蓑田 洋介, 江崎 充, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本食道学会学術集会プログラム・抄録集   77回   77 - 77   2023.6

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  • 難治性胃食道逆流症診療の最前線 難治性胃食道逆流症診療にボノプラザンが与える影響の検討

    水流 大尭, 畑 佳孝, 和田 将史, 牟田 和正, 蓑田 洋介, 江崎 充, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本食道学会学術集会プログラム・抄録集   77回   46 - 46   2023.6

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  • 特集 GERDを極める [各論 病態と診断] 非びらん性胃食道逆流症の病態と鑑別診断

    伊原 栄吉, 水流 大尭, 和田 将史, 畑 佳孝, 白 暁鵬, 田中 義将, 蓑田 洋介, 江崎 充, 荻野 治栄

    消化器内視鏡   35 ( 5 )   607 - 614   2023.5   ISSN:09153217

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    DOI: 10.24479/endo.0000000731

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  • 【GERDを極める】病態と診断 非びらん性胃食道逆流症の病態と鑑別診断

    伊原 栄吉, 水流 大尭, 和田 将史, 畑 佳孝, 白 暁鵬, 田中 義将, 蓑田 洋介, 江崎 充, 荻野 治栄

    消化器内視鏡   35 ( 5 )   607 - 614   2023.5

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  • 【GERDを極める】病態と診断 非びらん性胃食道逆流症の病態と鑑別診断

    伊原 栄吉, 水流 大尭, 和田 将史, 畑 佳孝, 白 暁鵬, 田中 義将, 蓑田 洋介, 江崎 充, 荻野 治栄

    消化器内視鏡   35 ( 5 )   607 - 614   2023.5   ISSN:0915-3217 ISBN:9784885636738

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  • A stepwise treatment strategy based on the pathophysiology of irritable bowel syndrome

    TANAKA Yoshimasa, OGINO Haruei, IHARA Eikichi

    Nippon Shokakibyo Gakkai Zasshi   120 ( 3 )   218 - 230   2023.3   ISSN:04466586 eISSN:13497693

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    <p>過敏性腸症候群の治療は食事と生活習慣を指導した後に,薬物療法の第1段階として消化管主体の治療を行う.第1選択薬として消化管運動機能調節薬,プロバイオティクス,高分子重合体を使用する.また,IBS分類に応じて下痢型には5-HT3拮抗薬,便秘型には粘膜上皮機能変容薬を投与する.症状の改善が不十分な場合は,優勢な症状に対して止痢薬,抗コリン薬,5-HT4刺激薬,下剤を追加する.さらに,漢方薬,抗アレルギー薬,胆汁酸関連薬や抗菌薬を考慮する.これらの薬物療法が無効な場合,第2段階として抗うつ薬,抗不安薬を用いた中枢機能の調整を含む治療を考慮する.さらに改善が得られない場合,心理療法を考慮する.</p>

    DOI: 10.11405/nisshoshi.120.218

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  • 良性食道疾患(GERD、運動異常症、裂孔ヘルニア)に対する内視鏡・外科治療 おにぎり食道造影検査を用いた非アカラシア性食道運動障害に対するPOEMの治療戦略の提案 胃側の筋層切開についての検討

    水流 大尭, 和田 将史, 畑 佳孝, 牟田 和正, 長友 周三郎, 蓑田 洋介, 江崎 充, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本消化管学会雑誌   7 ( Suppl. )   186 - 186   2023.1

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  • GERDの診断・病態・治療の新展開 ビリルビン検出能する新規内視鏡システムによる逆流過敏性食道の病態評価

    和田 将史, 蓑田 洋介, 水流 大尭, 畑 佳孝, 江崎 充, 長友 周三郎, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本消化管学会雑誌   7 ( Suppl. )   143 - 143   2023.1

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  • GERDの診断・病態・治療の新展開 ビリルビン検出能する新規内視鏡システムによる逆流過敏性食道の病態評価

    和田 将史, 蓑田 洋介, 水流 大尭, 畑 佳孝, 江崎 充, 長友 周三郎, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本消化管学会雑誌   7 ( Suppl. )   143 - 143   2023.1   ISSN:2433-3840 eISSN:2435-8967

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  • 良性食道疾患(GERD、運動異常症、裂孔ヘルニア)に対する内視鏡・外科治療 おにぎり食道造影検査を用いた非アカラシア性食道運動障害に対するPOEMの治療戦略の提案 胃側の筋層切開についての検討

    水流 大尭, 和田 将史, 畑 佳孝, 牟田 和正, 長友 周三郎, 蓑田 洋介, 江崎 充, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本消化管学会雑誌   7 ( Suppl. )   186 - 186   2023.1   ISSN:2433-3840 eISSN:2435-8967

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  • 上部消化管疾患の低侵襲治療 食道・胃噴門部平滑筋腫に対してPOETおよびPOEM手技併用の内視鏡外科手術で低侵襲に核出し得た6例

    水流 大尭, 和田 将史, 畑 佳孝, 長友 周三郎, 江崎 充, 蓑田 洋介, 田中 義将, 荻野 治栄, 進藤 幸治, 森山 大樹, 大内田 研宙, 伊原 栄吉

    日本消化器病学会九州支部例会・日本消化器内視鏡学会九州支部例会プログラム・抄録集   120回・114回   115 - 115   2022.12

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  • 上部消化管疾患の低侵襲治療 食道・胃噴門部平滑筋腫に対してPOETおよびPOEM手技併用の内視鏡外科手術で低侵襲に核出し得た6例

    水流 大尭, 和田 将史, 畑 佳孝, 長友 周三郎, 江崎 充, 蓑田 洋介, 田中 義将, 荻野 治栄, 進藤 幸治, 森山 大樹, 大内田 研宙, 伊原 栄吉

    日本消化器病学会九州支部例会・日本消化器内視鏡学会九州支部例会プログラム・抄録集   120回・114回   115 - 115   2022.12

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  • Auxiliary diagnosis of subepithelial lesions by impedance measurement during endoscopic ultrasound guided fine-needle biopsy. International journal

    Yosuke Minoda, Mitsuru Esaki, Eikichi Ihara, Shuzaburo Nagatomo, Kei Nishioka, Nao Fujimori, Haruei Ogino, Xiaopeng Bai, Yoshimasa Tanaka, Takatoshi Chinen, Qingjiang Hu, Mitsuhiko Ota, Shinya Umekita, Hidetaka Yamamoto, Yoshihiro Ogawa

    Gastrointestinal endoscopy   97 ( 5 )   977 - 984   2022.11   ISSN:0016-5107 eISSN:1097-6779

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    INTRODUCTION: Endoscopic ultrasound guided fine-needle aspiration/biopsy (EUS-FNA/B) is the gold standard for diagnosing subepithelial lesions (SELs); however, its diagnostic ability for SELs <20 mm is low. We developed a new diagnostic method to differentiate between gastrointestinal stromal tumor (GIST) and non-GIST by measuring high-frequency impedance (H-impedance) using an EUS-FNB needle. METHODS: The H-impedance of gastric epithelial neoplasms from 16 cases were measured using a conventional impedance probe to confirm whether H-impedance is clinically useful for assessing cell density (Study 1). The H-impedance values of exposed SELs from 25 cases using the conventional probe (Study 2) and non-exposed SELs from 20 cases using the EUS-FNB needle probe (Study 3) were measured to determine the diagnostic ability of H-impedance for differentiating GISTs from non-GISTs. RESULTS: H-impedance significantly positively correlated with cell density (P=0.030) (Study 1). The H-impedance of GIST (99.5) measured using conventional probe was significantly higher than those of the muscular layer (82.4) and leiomyoma (89.2) (P<0.01) (Study 2). The H-impedance of GIST measured using the EUS-FNB needle was also significantly higher than that of leiomyoma (GIST: 80.2 vs. leiomyoma: 71.8, P=0.015). The diagnostic yield of the impedance method for differentiating GISTs from non-GISTs had 94.4% accuracy, 88.9% sensitivity, 100% specificity, and 0.95 area under the curve. Diagnostic ability was not affected by lesion size (P=0.86) (Study 3). CONCLUSION: Auxiliary differential diagnosis between gastric GISTs and non-GISTs by the H-impedance measurement during EUS-FNB could be a good option especially when the lesion is smaller than 20 mm.

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  • 蠕動波出現と食道胃接合部上膨隆所見を用いた食道運動障害性疾患スクリーニングの食道造影改善(Improved esophagography screening for esophageal motility disorders using wave appearance and supra-junctional ballooning)

    Hata Yoshitaka, Ihara Eikichi, Wada Masafumi, Tsuru Hirotaka, Muta Kazumasa, Minoda Yosuke, Bai Xiaopeng, Esaki Mitsuru, Tanaka Yoshimasa, Chinen Takatoshi, Ogino Haruei, Sakamoto Ryuichi, Ogawa Yoshihiro

    Journal of Gastroenterology   57 ( 11 )   838 - 847   2022.11   ISSN:0944-1174

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    食道運動障害性疾患(EMD)を診断するための新たな2所見を用いたバリウム食道造影検査(BE)によるスクリーニングを評価した。2013年1月から2020年10月にEMDが疑われ高解像度マノメトリー検査(HRM)とBEの両方が施行された244例を対象とした。EMDの診断はシカゴ分類第3.0版を用いてHRM所見に基づいて行った。BEは硫酸バリウムを用いて食道連続撮影を行った。従来からのBE所見(ニボー、数珠状/コルク栓抜き様所見、蠕動の消失/減弱)に加え、新規2所見(蠕動波出現、胃食道接合部上膨隆所見)を診断に用いた。新規2所見と従来の3所見を診断に用いた場合のBEスクリーニングの感度は79.4%、特異度は88%であった(受信者動作特性曲線下領域(AUC)=0.837)。新規2所見を診断に用いない場合には、感度は63.9%、特異度は96%(AUC=0.800)であった。アカラシアはニボー形成と特に関連性が強かった(88.7%)。収縮の消失は蠕動の消失/減弱と強く関連していた(85.7%)。遠位食道痙攣と数珠状/コルク栓抜き様所見との間(60%)およびアカラシアと蠕動波出現(59.7%)との間には比較的高い関連性が認められた。個々のBE所見の観察者内再現性、観察者間一致率はそれぞれ84.4%、75%であった。蠕動波出現は積算弛緩圧(IRP)高値および遠位潜時短縮と関連していた。食道胃接合部上膨隆はIRP高値と関連していた。新規の2所見を追加したBEスクリーニングによるEMDの診断は一般診療において有用である可能性が示された。

  • Efficacy of ultrasound endoscopy with artificial intelligence for the differential diagnosis of non-gastric gastrointestinal stromal tumors. International journal

    Yosuke Minoda, Eikichi Ihara, Nao Fujimori, Shuzaburo Nagatomo, Mitsuru Esaki, Yoshitaka Hata, Xiaopeng Bai, Yoshimasa Tanaka, Haruei Ogino, Takatoshi Chinen, Qingjiang Hu, Eiji Oki, Hidetaka Yamamoto, Yoshihiro Ogawa

    Scientific reports   12 ( 1 )   16640 - 16640   2022.10   ISSN:2045-2322

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    Gastrointestinal stromal tumors (GISTs) are common subepithelial lesions (SELs) and require treatment considering their malignant potential. We recently developed an endoscopic ultrasound-based artificial intelligence (EUS-AI) system to differentiate GISTs from non-GISTs in gastric SELs, which were used to train the system. We assessed whether the EUS-AI system designed for diagnosing gastric GISTs could be applied to non-gastric GISTs. Between January 2015 and January 2021, 52 patients with non-gastric SELs (esophagus, n = 15; duodenum, n = 26; colon, n = 11) were enrolled. The ability of EUS-AI to differentiate GISTs from non-GISTs in non-gastric SELs was examined. The accuracy, sensitivity, and specificity of EUS-AI for discriminating GISTs from non-GISTs in non-gastric SELs were 94.4%, 100%, and 86.1%, respectively, with an area under the curve of 0.98 based on the cutoff value set using the Youden index. In the subanalysis, the accuracy, sensitivity, and specificity of EUS-AI were highest in the esophagus (100%, 100%, 100%; duodenum, 96.2%, 100%, 0%; colon, 90.9%, 100%, 0%); the cutoff values were determined using the Youden index or the value determined using stomach cases. The diagnostic accuracy of EUS-AI increased as lesion size increased, regardless of lesion location. EUS-AI based on gastric SELs had good diagnostic ability for non-gastric GISTs.

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  • Improved esophagography screening for esophageal motility disorders using wave appearance and supra-junctional ballooning.

    Yoshitaka Hata, Eikichi Ihara, Masafumi Wada, Hirotaka Tsuru, Kazumasa Muta, Yosuke Minoda, Xiaopeng Bai, Mitsuru Esaki, Yoshimasa Tanaka, Takatoshi Chinen, Haruei Ogino, Ryuichi Sakamoto, Yoshihiro Ogawa

    Journal of gastroenterology   57 ( 11 )   838 - 847   2022.8   ISSN:0944-1174 eISSN:1435-5922

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    BACKGROUND: High-resolution manometry (HRM) is the gold standard for diagnosing esophageal motility disorders (EMDs); however, it requires specialized equipment. The development of more accessible screening examinations is expected. We evaluated the utility of barium esophagography (BE) screening using two novel findings to diagnose EMDs. METHODS: Between January 2013 and October 2020, 244 patients with suspected EMDs who underwent both HRM and BE were analyzed. The EMD diagnosis was based on HRM findings using Chicago Classification version 3.0. BE was performed using sequential esophagography with barium sulfate. Three conventional BE findings (air-fluid level, rosary-bead/corkscrew appearance, and absent/weak peristalsis) and two novel BE findings (wave appearance and supra-junctional ballooning) were used for diagnosis. RESULTS: The sensitivity and specificity of BE screening using the two novel findings and conventional findings to diagnose EMDs were 79.4% and 88%, respectively [area under the receiver-operating characteristic curve (AUC) = 0.837]. Without these novel findings, they were 63.9% and 96%, respectively (AUC = 0.800), respectively. Achalasia was highly correlated with the air-fluid level (88.7%). Absent contractility was highly correlated with absent/weak peristalsis (85.7%). Relatively high correlations were observed between distal esophageal spasm and rosary-bead/corkscrew appearance (60%), and between achalasia and wave appearance (59.7%). The intra-observer reproducibility and inter-observer agreement for individual BE findings were 84.4% and 75%, respectively. Wave appearance was associated with higher integrated relaxation pressure (IRP) and shorter distal latency. Supra-junctional ballooning was associated with higher IRP. CONCLUSIONS: BE screening using two additional novel findings to diagnose EMDs could be useful in general practice.

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  • Determination of Region-Specific Roles of the M3 Muscarinic Acetylcholine Receptor in Gastrointestinal Motility. International journal

    Yoko Igarashi-Hisayoshi, Eikichi Ihara, Xiaopeng Bai, Chika Higashi, Hiroko Ikeda, Yoshimasa Tanaka, Mayumi Hirano, Haruei Ogino, Takatoshi Chinen, Yasushi Taguchi, Yoshihiro Ogawa

    Digestive diseases and sciences   68 ( 2 )   439 - 450   2022.8

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    BACKGROUND: The specific role of the M3 muscarinic acetylcholine receptor in gastrointestinal motility under physiological conditions is unclear, due to a lack of subtype-selective compounds. AIMS: The objective of this study was to determine the region-specific role of the M3 receptor in gastrointestinal motility. METHODS: We developed a novel positive allosteric modulator (PAM) for the M3 receptor, PAM-369. The effects of PAM-369 on the carbachol-induced contractile response of porcine esophageal smooth muscle and mouse colonic smooth muscle (ex vivo) and on the transit in mouse small intestine and rat colon (in vivo) were examined. RESULTS: PAM-369 selectively potentiated the M3 receptor under the stimulation of its orthosteric ligands without agonistic or antagonistic activity. Half-maximal effective concentrations of PAM activity for human, mouse, and rat M3 receptors were 0.253, 0.345, and 0.127 μM, respectively. PAM-369 enhanced carbachol-induced contraction in porcine esophageal smooth muscle and mouse colonic smooth muscle without causing any contractile responses by itself. The oral administration of 30 mg/kg PAM-369 increased the small intestinal transit in both normal motility and loperamide-induced intestinal dysmotility mice but had no effects on the colonic transit, although the M3 receptor mRNA expression is higher in the colon than in the small intestine. CONCLUSIONS: This study provided the first direct evidence that the M3 receptor has different region-specific roles in the motility function between the small intestine and colon in physiological and pathophysiological contexts. Selective PAMs designed for targeted subtypes of muscarinic receptors are useful for elucidating the subtype-specific function.

    DOI: 10.1007/s10620-022-07637-y

  • 胃食道流出路閉塞に対するアコチアミドの治療有効性 前向き縦断的観察研究(The treatment effects of acotiamide in esophagogastric outflow obstruction: a prospective longitudinal observational study)

    Ihara Eikichi, Ogino Haruei, Muta Kazumasa, Hamada Shohei, Wada Masafumi, Hata Yoshitaka, Ikeda Hiroko, Bai Xiaopeng, Minoda Yosuke, Esaki Mitsuru, Tanaka Yoshimasa, Chinen Takatoshi, Ogawa Yoshihiro

    Esophagus   19 ( 2 )   332 - 342   2022.4   ISSN:1612-9059

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    消化管運動改善薬であるアコチアミドの、食道胃接合部流出路閉塞(EGJOO)に対する有効性を検討した。2014年10月から2020年3月までの間に、EGJOO 25例に対してアコチアミド(100mg、1日3回)を4週間投与した。治療開始直前と治療後に高解像度マノメトリー検査(HRM)を施行した。主要評価項目である積算弛緩厚(IRP)は、治療前(19.4、17.1-27.4mmHg)と比較して治療後(14.6、12.1-22.0mmHg)で有意に低かった。下部食道括約筋(LES)調節指数も、治療後(32.7,21.0-40.0mmHg)が治療前(39.3,31.2-50.2mmHg)と比較して有意に低かった。アコチアミドは、EGJOO25症例中13例(52%)でIRPを正常化(<15mmHg)し、IRPは25例のEGJOO症例中20例(80%)でIRPを減少させた。副次評価項目であるFSSGスコアには、治療前と治療後で有意な変化は認められなかった。アコチアミドが奏効した13例を対象としたサブグループ解析では、アコチアミドにより嚥下障害が有意に改善していた。アコチアミドは、基礎LES圧およびLES調節反応の両方を低下させることによりIRP値を減少させることで、EGJOO患者において治療効果を示すことが明らかになった。

  • 【胃食道逆流症(GERD)ガイドラインの改正をめぐって】Barrett食道の発癌予防の諸問題

    畑 佳孝, 伊原 栄吉, 和田 将史, 水流 大尭, 江崎 充, 蓑田 洋介, 白 暁鵬, 田中 義将, 荻野 治栄

    消化器・肝臓内科   10 ( 5 )   551 - 560   2021.11

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  • The treatment effects of acotiamide in esophagogastric outflow obstruction: a prospective longitudinal observational study Invited Reviewed International journal

    Ihara E, Ogino H, Muta K, Hamada S, Wada M, Hata Y, Ikeda H, Bai X, Minoda Y, Esaki M, Tanaka Y, Chinen T, Ogawa Y.

    ESOPHAGUS   19 ( 2 )   332 - 342   2021.10   ISSN:1612-9059 eISSN:1612-9067

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    OBJECTIVES: We have found that an altered lower esophageal sphincter (LES) accommodation response is an underlying cause of esophagogastric junction outflow obstruction (EGJOO). The objective of this study was to examine the treatment effect of acotiamide, a prokinetic agent which improves impaired gastric accommodation in functional dyspepsia, in patients with EGJOO. METHODS: A prospective observational longitudinal study was conducted between October 2014 and March 2020. Acotiamide (100 mg, 3 times a day) was administered to 25 patients with EGJOO for 4 weeks. High-resolution manometry (HRM) was performed just before and after 4 weeks of treatment. RESULTS: As the primary outcome, the extent of integrated relaxation pressure (IRP) after treatment (14.6, 12.1-22.0 mmHg) was significantly lower than that before treatment (19.4, 17.1-27.4 mmHg). The extent of LES accommodation index after treatment (32.7, 21.0-40.0 mmHg) was also significantly lower than that before treatment (39.3, 31.2-50.2 mmHg). Acotiamide normalized the IRP (< 15 mmHg) in 13 of 25 patients with EGJOO (52&#37;), and the IRP was decreased in 20 of 25 patients with EGJOO (80&#37;). As the secondary outcome, the total FSSG score in 25 patients with EGJOO before and after acotiamide treatment showed no significant difference. In a sub-analysis of 13 patients in whom EGJOO was normalized by acotiamide, however, dysphagia was reported to be significantly improved by acotiamide. CONCLUSIONS: Acotiamide has a treatment effect on patients with EGJOO via a reduction in the IRP level through the lowering of both the basal LES pressure and LES accommodation response. Dysphagia is a key symptom to be evaluated and treated in patients with EGJOO.

    DOI: 10.1007/s10388-021-00887-1

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  • 食道運動異常症、裂孔ヘルニアの診断・病態・治療 病的意義のあるEGJOOに対する臥位/座位IRP、accommodation measurementの診断能の検討

    和田 将史, 水流 大尭, 池田 浩子, 大塚 宜寛, 畑 佳孝, 牟田 和正, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本食道学会学術集会プログラム・抄録集   75回   55 - 55   2021.9

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  • 嚥下時におけるLES accommodationの生理的・病理的役割(Physiological and pathological roles of the LES accommodation during swallowing)

    牟田 和正, 伊原 栄吉, 池田 浩子, 和田 将史, 水流 大尭, 畑 佳孝, 白 暁鵬, 田中 義将, 荻野 治栄, 小川 佳宏

    日本食道学会学術集会プログラム・抄録集   75回   76 - 76   2021.9

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  • GERDの診断・病態・治療の最新の知見 全身性強皮症患者の食道クリアランス機能評価におけるおにぎり食道造影検査法の検討

    水流 大尭, 和田 将史, 池田 浩子, 大塚 宜寛, 畑 佳孝, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本食道学会学術集会プログラム・抄録集   75回   14 - 14   2021.9

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  • Involvement of interstitial cells of Cajal in nicotinic acetylcholine receptor-induced relaxation of the porcine lower esophageal sphincter. Invited Reviewed International journal

    Otsuka Y, Bai X, Tanaka Y, Ihara E, Chinen T, Ogino H, Ogawa Y.

    European journal of pharmacology   910   174491 - 174491   2021.9

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    The interstitial cells of Cajal (ICCs) play an important role in coordinated gastrointestinal motility. The present study aimed to elucidate whether or how ICCs are involved in the lower esophageal sphincter (LES) relaxation induced by stimulation of the nicotinic acetylcholine receptor. The application of 1,1-dimethyl-4-phenyl-piperazinium (DMPP; a nicotinic acetylcholine receptor agonist) induced a transient relaxation in the circular smooth muscle of the porcine LES. DMPP-induced relaxation was abolished by not only 1 μM tetrodotoxin but also the inhibition of ICC activity by pretreatment with 100 μM carbenoxolone (a gap junction inhibitor), pretreatment with 100 μM CaCCinh-A01 (an anoctamin-1 blocker acting as a calcium-activated chloride channel inhibitor), and pretreatment with Cl--free solution. However, pretreatment with 100 μM Nω-nitro-L-arginine methyl ester had little effect on DMPP-induced relaxation. Furthermore, DMPP-induced relaxation was inhibited by pretreatment with 1 mM suramin, a purinergic P2 receptor antagonist, but not by 1 μM VIP (6-28), a vasoactive intestinal peptide (VIP) receptor antagonist. Stimulation of the purinergic P2 receptor with adenosine triphosphate (ATP) induced relaxation, which was abolished by the inhibition of ICC activity by pretreatment with CaCCinh-A01. In conclusion, membrane hyperpolarization of the ICCs via the activation of anoctamin-1 plays a central role in DMPP-induced relaxation. ATP may be a neurotransmitter for inhibitory enteric neurons, which stimulate the ICCs. The ICCs act as the interface of neurotransmission of nicotinic acetylcholine receptor in order to induce LES relaxation.

    DOI: 10.1016/j.ejphar.2021.174491

  • Mucosal IL23A expression predicts the response to Ustekinumab in inflammatory bowel disease.

    Kei Nishioka, Haruei Ogino, Takatoshi Chinen, Eikichi Ihara, Yoshimasa Tanaka, Kazuhiko Nakamura, Yoshihiro Ogawa

    Journal of gastroenterology   2021.8

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    BACKGROUND: Biologics against tumor necrosis factor-α (TNF) and the p40 subunit of interleukin (IL)-12 and IL-23 are increasingly used in inflammatory bowel disease (IBD) treatment. However, information on response prediction to these agents is limited. Thus, we aimed to identify factors for IBD treatment response prediction. METHODS: We conducted a retrospective study in 33 IBD subjects for anti-TNF and a prospective study of 23 IBD and 11 non-IBD subjects for ustekinumab (UST). Mucosal biopsy specimens were obtained before treatment with biologics. The expression of 18 immune-related genes encoding representative cytokines and transcription factors was analyzed by quantitative polymerase chain reaction. RESULTS: There was no difference between the treatment-resistant and -sensitive groups with regard to clinical characteristics. A higher expression of oncostatin M (OSM) and its receptor OSMR in the intestinal mucosa was most strongly associated with anti-TNF resistance, whereas lower IL23A expression was most strongly associated with UST resistance. In addition to the absolute expression levels of genes, concordant or discordant expression patterns of particular gene sets were associated with treatment sensitivity and resistance. CONCLUSIONS: The association of anti-TNF resistance and mucosal OSM and OSMR expression was consistent with the results of a previous study in a European cohort. Our observation that IBD subjects with higher mucosal IL23A expression were more likely to achieve remission by UST has not been previously reported. The response to biologics may thus be predicted in IBD patients through the analysis of mucosal gene expression levels and patterns.

    DOI: 10.1007/s00535-021-01819-7

  • Mucosa-associated gut microbiota reflects clinical course of ulcerative colitis Invited Reviewed International journal

    Nishihara Y, Ogino H, Tanaka M, Ihara E, Fukaura K, Nishioka K, Chinen T, Tanaka Y, Nakayama J, Kang D, Ogawa Y.

    SCIENTIFIC REPORTS   11 ( 1 )   13743 - 13743   2021.7

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    This longitudinal study was designed to elucidate whether gut microbiota is associated with relapse and treatment response in ulcerative colitis (UC) patients. Fifty-one patients with UC were enrolled between 2012 and 2017, and followed up through 2020. Colon mucosal biopsy were obtained at enrollment, and 16S ribosomal RNA sequencing was performed using extracted RNA. Of the 51 patients, 24 were in remission and 27 had active UC at enrollment. Of the 24 patients in remission, 17 maintained remission and 7 developed relapse during follow-up. The 7 patients with relapse showed lower diversity, with a lower proportion of Clostridiales (p = 0.0043), and a higher proportion of Bacteroides (p = 0.047) at enrollment than those without relapse. The 27 patients with active UC were classified into response (n = 6), refractory (n = 13), and non-response (n = 8) groups according to their treatment response in 6 months. The refractory and non-response groups showed lower diversity with a lower proportion of Prevotella (p = 0.048 and 0.043) at enrollment than the response group. This study is the first demonstration that reduced diversity and particular microbes are associated with the later clinical course of relapse events and treatment response in UC.

    DOI: 10.1038/s41598-021-92870-0

  • Onigiri esophagography as a screening test for esophageal motility disorders. Invited Reviewed International journal

    Hamada S, Ihara E, Muta K, Wada M, Hata Y, Ikeda H, Tanaka Y, Ogino H, Chinen T, Ogawa Y.

    Journal of neurogastroenterology and motility   28 ( 1 )   43 - 52   2021.7   ISSN:2093-0879 eISSN:2093-0887

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    Background/Aims: No screening test for esophageal motility disorder (EMD) has been established, the objective of this study is to examine the potential usefulness of our newly developed "Onigiri esophagography" combined with an obstruction level (OL) classification system in screening for EMD. Methods: A total of 102 patients with suspected EMDs who underwent both high-resolution manometry (HRM) and Onigiri esophagography between April 2017 and January 2019 were examined. The EMD diagnosis was performed based on the Chicago classification version 3.0 by HRM. Onigiri esophagography was performed using a liquid medium (barium sulfate) followed by a solid medium, which consisted of an Onigiri (a Japanese rice ball) with barium powder. The extent of medium obstruction was assessed by the OL classification, which was defined in a stepwise fashion from OL0 (no obstruction) to OL4 (severe obstruction). Results: The patients with OL0 (32.3&#37;), OL1 (50.0&#37;), OL2 (88.0&#37;), OL3 (100.0&#37;), and OL4 (100.0&#37;) were diagnosed EMDs by HRM. The area under the curve, as determined by a receiver operating characteristic analysis, for the OL classification was 0.86. Using the cutoff value of OL1, the sensitivity and specificity were 87.3&#37; and 61.3&#37;, respectively, while using a cutoff value of OL2, the sensitivity and specificity were 73.2&#37; and 90.3&#37;, respectively. Conclusion: In conclusion, Onigiri esophagography combined with the OL classification system can be used as a screening test for EMDs with a cutoff value of OL1.

    DOI: 10.5056/jnm20138

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  • 膵・消化管神経内分泌腫瘍の診断・治療の現状と問題点 当科における直腸神経内分泌腫瘍に対する診断・治療の現状と課題

    林 康代, 荻野 治栄, 蓑田 洋介, 田中 義将, 畑 佳孝, 伊原 栄吉

    日本消化器病学会九州支部例会・日本消化器内視鏡学会九州支部例会プログラム・抄録集   117回・111回   81 - 81   2021.6

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  • USEFULNESS OF ONIGIRI ESOPHAGOGRAPHY COMBINED WITH AN OBSTRUCTION LEVEL CLASSIFICATION SYSTEM IN SCREENING ESOPHAGEAL MOTILITY DISORDERS

    Eikichi Ihara, Shohei Hamada, Kazumasa Muta, Masafumi Wada, Yoshitaka Hata, Hiroko Ikeda, Yoshimasa Tanaka, Haruei Ogino, Takatoshi Chinen, Yoshihiro Ogawa

    GASTROENTEROLOGY   160 ( 6 )   S648 - S649   2021.5

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  • Physiological and pathological roles of the accommodation response in lower esophageal sphincter relaxation during wet swallows. Invited Reviewed International journal

    Muta K, Ihara E, Hamada S, Ikeda H, Wada M, Hata Y, Bai X, Nishihara Y, Tanaka Y, Ogino H, Ogawa Y

    Scientific reports   11 ( 1 )   7898 - 7898   2021.4

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    The preparatory accommodation response of lower esophageal sphincter (LES) before swallowing is one of the mechanisms involved in LES relaxation during wet swallows, however, the physiological and/or pathological roles of LES accommodation remain to be determined in humans. To address this problem, we conducted a prospective observational study of 38 patients with normal high-resolution manometry (HRM) and 23 patients with idiopathic esophagogastric junction outflow obstruction (EGJOO) to assess dry and wet swallows. The LES accommodation measurement was proposed for practical use in evaluating the LES accommodation response. Although swallow-induced LES relaxation was observed in both dry and wet swallows, LES accommodation (6.4, 3.1-11.1 mmHg) was only observed in wet swallows. The extent of LES accommodation was impaired in idiopathic EGJOO (0.6, - 0.6-6 mmHg), and the LES accommodation measurement of patients with idiopathic EGJOO (36.8, 29.5-44.3 mmHg) was significantly higher in comparison to those with normal HRM (23.8, 18-28.6 mmHg). Successful LES relaxation in wet swallowing can be achieved by LES accommodation in combination with swallow-induced LES relaxation. Impaired LES accommodation is characteristic of idiopathic EGJOO. In addition to the IRP value, the LES accommodation measurement may be useful for evaluating the LES relaxation function in clinical practice.

    DOI: 10.1038/s41598-021-87052-x

  • Role of the IL-23-T-bet/GATA3 Axis for the Pathogenesis of Ulcerative Colitis. Reviewed International journal

    Ogino H, Fukaura K, Iboshi Y, Nagamatsu Y, Okuno H, Nishioka K, Nishihara Y, Tanaka Y, Chinen T, Ihara E, Ogawa Y.

    Inflammation. 2021 Apr;44(2):592-603.   44 ( 2 )   592 - 603   2021.4

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    DOI: 10.1007/s10753-020-01358-y

  • Discriminant equation using mucosally expressed cytokines and transcription factor for making definite diagnosis of inflammatory bowel disease unclassified Invited Reviewed International journal

    Okuno H, Ogino H, Ihara E, Nishioka K, Tanaka Y, Chinen T, Kohjima M, Oono T, Tanaka M, Goya T, Fujimori N, Iboshi Y, Gotoda T, Ogawa Y

    BMC GASTROENTEROLOGY   21 ( 1 )   73 - 73   2021.2

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    BACKGROUND: The pathological conditions of UC and CD involved in inflammatory bowel disease-unclassified (IBD-U), UC with primary sclerosing cholangitis (PSC-UC), and UC with autoimmune pancreatitis type 2 (AIP-UC) remain unclear. Therefore, it is difficult to decide the appropriate treatments for these subtypes of UC. Our aim was to examine whether the discriminant equation using the mucosally expressed mediators designed as our previous study for IBD, could characterize IBD-U, PSC-UC, or AIP-UC. METHODS: A total of 56 patients including UC (n = 24), CD (n = 15), IBD-U (n = 10), PSC-UC (n = 4), and AIP-UC (n = 3), along with 9 control patients were enrolled in this study. Mucosally expressed inflammatory mediators related to Th1, Th2, Th17, and Treg were measured using quantitative PCR in endoscopic biopsies from the inflamed intestines of the patients. The IBD-U, PSC-UC or AIP-UC were characterized using discriminant analysis and principle component analysis. RESULTS: Through discriminant analyses, combinations of 3 to 7 inflammatory mediators were used to discriminate between UC and CD. Moreover, the identified 3 markers could diagnose patients with IBD-U as UC or CD with high accuracy. The distribution graph of inflammatory mediators using the principal component analysis revealed that PSC-UC and AIP-UC exhibited CD-like and UC-like features, respectively. CONCLUSIONS: The discriminant equation using mucosally expressed mediators of IL-13, IL-21 and T-bet can be used as a universal diagnostic tool not only for IBD-U but also to assess pathological conditions in PSC-UC and AIP-UC.

    DOI: 10.1186/s12876-021-01656-1

  • 食道疾患に対する治療法の進歩とその成績 内視鏡・胸腔鏡合同手術で切除し得た巨大食道平滑筋腫の2例

    水流 大尭, 畑 佳孝, 和田 将史, 蓑田 洋介, 小森 圭司, 田中 義将, 荻野 治栄, 伊原 栄吉

    日本消化器病学会九州支部例会プログラム・抄録集   116回   101 - 101   2020.12

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  • 【これだけは知っておきたい消化管疾患の診断・治療】消化管における慢性炎症

    荻野 治栄, 田中 義将, 知念 孝敏, 小森 圭司, 伊原 栄吉, 小川 佳宏

    消化器クリニカルアップデート   2 ( 1 )   24 - 28   2020.8

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    消化管は断続的な食物の流入と1,000種に及ぶ腸内微生物叢の存在という独特の環境下で機能する臓器である。このような過酷な環境下でいかにして健康が維持され、何がその破綻を引き起こすのか、いまだ明らかになっていないことも多い。消化管における慢性炎症の持続は、炎症性腸疾患(Inflammatory bowel disease:IBD)のみならず、過敏性腸症候群(Irritable bowel disease:IBS)をはじめとする機能性疾患の病態にも関与することが示唆されている。本稿では、炎症、免疫の観点から、消化管疾患、とくにIBD・IBS研究の要点を見直し、最新の知見やその解釈の注意点も含め考察する。(著者抄録)

  • Involvement of different receptor subtypes in prostaglandin E2-induced contraction and relaxation in the lower esophageal sphincter and esophageal body Reviewed

    Xiaopeng Bai, Eikichi Ihara, Yoshihihro Otsuka, Shinichi Tsuruta, Katsuya Hirano, Yoshimasa Tanaka, Haruei Ogino, Mayumi Hirano, Takatoshi Chinen, Hirotada Akiho, Kazuhiko Nakamura, Yoshinao Oda, Yoshihiro Ogawa

    European Journal of Pharmacology   857   2019.8

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    Prostaglandin E2 (PGE2) plays a role in the pathogenesis of gastro-esophageal reflux disease (GERD). There are 4 subtypes of PGE2, PGE2 receptor 1, 2, 3 and 4 (EP 1–4). In GERD patents, PGE2, EP2 and EP4 are upregulated. However, the effects of PGE2 on esophageal motility remain elusive. We examined how PGE2 regulates motility in the porcine circular smooth muscle of the lower esophageal sphincter (LES), and the circular and longitudinal smooth muscle of the esophagus body in organ bath. PGE2 induced tonic relaxation in the LES and circular smooth muscle, but transient contraction in longitudinal smooth muscle. The relaxation of the LES and circular smooth muscle was similar in pattern and mechanism, but was much larger in the LES. The relaxation was completely blocked by a voltage-gated K+ channel blocker or 40 mM K+ depolarization, indicating the involvement of K+ channel. Longitudinal smooth muscle contraction was completely blocked by an L-type Ca2+ channel blocker, showing the contribution of Ca2+ movement. The involvement of the EP receptor in motility was examined with selective receptor agonists and antagonists. Activation of EP2 and EP4 caused relaxation in the LES and circular smooth muscle. Compatible with PGE2, EP2 and EP4 agonists caused more significant relaxation in the LES than in circular smooth muscle. EP1 contributed to the longitudinal smooth muscle contraction. The different effects of PGE2 in the LES, circular and longitudinal smooth muscle contributes to esophageal motility, their impairment might increase the amount and frequency of esophageal reflux.

    DOI: 10.1016/j.ejphar.2019.172405

  • Clinical Characterization of Vonoprazan-Refractory Gastroesophageal Reflux Disease Reviewed International journal

    Shohei Hamada, Eikichi Ihara, Hiroko Ikeda, Kazumasa Muta, Haruei Ogino, Takatoshi Chinen, Yoshimasa Tanaka, Yoshihiro Ogawa

    Digestion   102 ( 2 )   197 - 204   2019.1

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    Introduction: The newly developed vonoprazan (a potassium-competitive acid blocker) has a greater ability to suppress gastric acid production than convention proton pump inhibitors (PPIs). The objective of the present study was to determine how vonoprazan influences the pathogenesis of refractory gastroesophageal reflux disease (GERD) in clinical practice. Methods: Between March 2013 and November 2018, a total of 73 refractory GERD patients (34 in the conventional PPI group versus 39 in the vonoprazan group) were enrolled in this retrospective study. We then compared the underlying disease conditions between the 2 groups, examined by high-resolution manometry and multichannel intraluminal impedance/pH (MII-pH) monitoring. Results: There was a significant difference in the proportion of underlying disease conditions, including erosive esophagitis, non-erosive reflux disease, reflux hypersensitivity, functional heartburn and oesophageal motility disorder (EMD), between the conventional PPI (6, 14, 23, 40 and 17&#37; respectively) and vonoprazan groups (0, 0, 10, 49, and 41&#37; respectively; p < 0.01). No cases of acid-related GERD were observed in the vonoprazan group. When the EMD patients were excluded, the lower oesophageal acid exposure time of the vonoprazan group (0.1&#37; [0.0-0.5&#37;], n = 23) was significantly lower than that of the conventional PPI group (0.35&#37; [0.1-3.9&#37;], n = 28; p < 0.05), and the gastric pH <4 holding time of the vonoprazan group (7.7&#37; [0.7-34.5&#37;]) was also significantly lower than that of the conventional PPI group (61.6&#37; [49.4-74.3&#37;], p < 0.01). Conclusions: Vonoprazan serves as a diagnostic tool to exclude acid-related GERD.

    DOI: 10.1159/000503340

  • Clinical Characterization of Vonoprazan-Refractory Gastroesophageal Reflux Disease Reviewed

    Shohei Hamada, Eikichi Ihara, Hiroko Ikeda, Kazumasa Muta, Haruei Ogino, Takatoshi Chinen, Yoshimasa Tanaka, Yoshihiro Ogawa

    Digestion   2019.1

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    Introduction: The newly developed vonoprazan (a potassium-competitive acid blocker) has a greater ability to suppress gastric acid production than convention proton pump inhibitors (PPIs). The objective of the present study was to determine how vonoprazan influences the pathogenesis of refractory gastroesophageal reflux disease (GERD) in clinical practice. Methods: Between March 2013 and November 2018, a total of 73 refractory GERD patients (34 in the conventional PPI group versus 39 in the vonoprazan group) were enrolled in this retrospective study. We then compared the underlying disease conditions between the 2 groups, examined by high-resolution manometry and multichannel intraluminal impedance/pH (MII-pH) monitoring. Results: There was a significant difference in the proportion of underlying disease conditions, including erosive esophagitis, non-erosive reflux disease, reflux hypersensitivity, functional heartburn and oesophageal motility disorder (EMD), between the conventional PPI (6, 14, 23, 40 and 17% respectively) and vonoprazan groups (0, 0, 10, 49, and 41% respectively; p < 0.01). No cases of acid-related GERD were observed in the vonoprazan group. When the EMD patients were excluded, the lower oesophageal acid exposure time of the vonoprazan group (0.1% [0.0-0.5%], n = 23) was significantly lower than that of the conventional PPI group (0.35% [0.1-3.9%], n = 28; p < 0.05), and the gastric pH <4 holding time of the vonoprazan group (7.7% [0.7-34.5%]) was also significantly lower than that of the conventional PPI group (61.6% [49.4-74.3%], p < 0.01). Conclusions: Vonoprazan serves as a diagnostic tool to exclude acid-related GERD.

    DOI: 10.1159/000503340

  • Clutch Cutter knife efficacy in endoscopic submucosal dissection for early gastric neoplasms Reviewed International journal

    Yasuyo Hayashi, Mitsuru Esaki, Sho Suzuki, Eikichi Ihara, Azusa Yokoyama, Seiichiro Sakisaka, Taizo Hosokawa, Yoshimasa Tanaka, Takahiro Mizutani, Shinichi Tsuruta, Aya Iwao, Shun Yamakawa, Akira Irie, Yosuke Minoda, Yoshitaka Hata, Haruei Ogino, Hirotada Akiho, Yoshihiro Ogawa

    World Journal of Gastrointestinal Oncology   10 ( 12 )   487 - 495   2018.12

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    AIM To compare the outcomes of endoscopic submucosal dissection (ESD) for gastric neoplasms using Clutch Cutter (ESD-C) or other knives (ESD-O). METHODS This was a single-center retrospective study. Gastric neoplasms treated by ESD between April 2016 and October 2017 at Kitakyushu Municipal Medical Center were reviewed. Multivariate analyses and propensity score matching were used to reduce biases. Covariates included factors that might affect outcomes of ESD, including age, sex, underlying disease, anti-thrombotic drugs use, tumor location, tumor position, tumor size, tumor depth, tumor morphology, tumor histology, ulcer (scar), and operator skill. The treatment outcomes were compared among two groups. The primary outcome was ESD procedure time. Secondary outcomes were en bloc, complete, and curative resection rates, and adverse events rates including perforation and delayed bleeding. RESULTS A total of 155 patients were included in this study; 44 pairs were created by propensity score matching. Background characteristics were quite similar among two groups after matching. Procedure time was significantly shorter for ESD-C (median; 49 min) than for ESD-O (median; 88.5 min) (P < 0.01). However, there was no significant difference in treatment outcomes between ESD-C and ESD-O including en bloc resection rate (100&#37; in both groups), complete resection rate (100&#37; in both groups), curative resection rate (86.4&#37; vs 88.6&#37;, P = 0.730), delayed bleeding (2.3&#37; vs 6.8&#37;, P = 0.62) and perforation (0&#37; in both groups). CONCLUSION ESD-C achieved shorter procedure time without an increase in complication risk. Therefore, ESD-C could become an effective ESD option for gastric neoplasms.

    DOI: 10.4251/wjgo.v10.i12.487

  • COMPARISON BETWEEN CLUTCH CUTTER AND OTHER DEVICES IN THE TECHNICAL OUTCOMES IN ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER

    Yasuyo Hayashi, Mitsuru Esaki, Taizo Hosokawa, Yoshimasa Tanaka, Haruei Ogino, Takahiro Mizutani, Eikichi Ihara, Hirotada Akiho

    GASTROINTESTINAL ENDOSCOPY   87 ( 6 )   AB266 - AB266   2018.6

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  • Endogenous Hydrogen Sulfide Contributes to Tone Generation in Porcine Lower Esophageal Sphincter Via Na+/Ca2+ Exchanger Reviewed

    Xiaopeng Bai, Eikichi Ihara, Katsuya Hirano, Yoshimasa Tanaka, Kayoko Nakano, Satomi Kita, Takahiro Iwamoto, Haruei Ogino, Mayumi Hirano, Yoshinao Oda, Kazuhiko Nakamura, Yoshihiro Ogawa

    CMGH   5 ( 3 )   209 - 221   2018.3

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    Background and Aims: Hydrogen sulfide (H2S) is a major physiologic gastrotransmitter. Its role in the regulation of the lower esophageal sphincter (LES) function remains unknown. The present study addresses this question. Methods: Isometric contraction was monitored in circular smooth muscle strips of porcine LES. Changes in cytosolic Ca2+ concentration ([Ca2+]i) and force were simultaneously monitored in fura-2-loaded strips with front-surface fluorometry. The contribution of endogenous H2S to LES contractility was investigated by examining the effects of inhibitors of H2S-generating enzymes, including cystathionine-β-synthase, cystathionine-γ-lyase, and 3-mercaptopyruvate sulfurtransferase, on the LES function. Results: Porcine LES strips myogenically maintained a tetrodotoxin-resistant basal tone. Application of AOA (cystathionine-β-synthase inhibitor) or L-aspartic acid (L-Asp; 3-mercaptopyruvate sulfurtransferase inhibitor) but not DL-PAG (cystathionine-γ-lyase inhibitor), decreased this basal tone. The relaxant effects of AOA and L-Asp were additive. Maximum relaxation was obtained by combination of 1 mM AOA and 3 mM L-Asp. Immunohistochemical analyses revealed that cystathionine-β-synthase and 3-mercaptopyruvate sulfurtransferase, but not cystathionine-γ-lyase, were expressed in porcine LES. AOA+L-Asp–induced relaxation was accompanied by a decrease in [Ca2+]i and inversely correlated with the extracellular Na+ concentration ([Na+]o) (25-137.4 mM), indicating involvement of an Na+/Ca2+ exchanger. The reduction in the basal [Ca2+]i level by AOA was significantly augmented in the antral smooth muscle sheets of Na+/Ca2+ exchanger transgenic mice compared with wild-type mice. Conclusions: Endogenous H2S regulates the LES myogenic tone by maintaining the basal [Ca2+]i via Na+/Ca2+ exchanger. H2S-generating enzymes may be a potential therapeutic target for esophageal motility disorders, such as achalasia.

    DOI: 10.1016/j.jcmgh.2017.11.004

  • Trypsin induces biphasic muscle contraction and relaxation via transient receptor potential vanilloid 1 and neurokinin receptors 1/2 in porcine esophageal body Reviewed

    Bai Xiaopeng, Yoshimasa Tanaka, Eikichi Ihara, Katsuya Hirano, Kayoko Nakano, Mayumi Hirano, Yoshinao Oda, Kazuhiko Nakamura

    European Journal of Pharmacology   797   65 - 74   2017.1

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    Duodenal reflux of fluids containing trypsin relates to refractory gastroesophageal reflux disease (GERD). Esophageal peristalsis and clearance are important factors in GERD pathogenesis. However, the function of trypsin in esophageal body contractility is not fully understood. In this study, effects of trypsin on circular smooth muscle (CSM) and longitudinal smooth muscle (LSM) of the porcine esophageal body were examined. Trypsin elicited a concentration dependent biphasic response, a major contraction and a subsequent relaxation only in CSM. In CSM, contraction occurred at trypsin concentrations of 100 nM and relaxation at 1 μM. A proteinase-activated receptor (PAR)2 activating peptide, SLIGKV-NH2(1 mM), induced a monophasic contraction. Those responses were unaffected by tetrodotoxin though abolished by the gap junction uncouplers carbenoxolone and octanol. They were also partially inhibited by a transient receptor potential vanilloid type 1 (TRPV1) antagonist and abolished by combination of neurokinin receptor 1 (NK1) and NK2antagonists, but not by an NK3antagonist, suggesting a PAR2-TRPV1-substance P pathway in sensory neurons. Substance P (100 nM), an agonist for various NK receptors (NK1, NK2and NK3) with differing affinities, induced significant contraction in CSM, but not in LSM. The contraction was also blocked by the combination of NK1and NK2antagonists, but not by the NK3antagonist. Moreover, substance P-induced contractions were unaffected by the TRPV1 antagonist, but inhibited by a gap junction uncoupler. In conclusion, trypsin induced a biphasic response only in CSM and this was mediated by PAR2, TRPV1 and NK1/2. Gap junctions were indispensable in this tachykinin-induced response.

    DOI: 10.1016/j.ejphar.2017.01.004

  • Endogenous H2S maintains myogenic tone in lower esophageal sphincter: A possible target for treatment of lower esophageal sphincter dysfunction

    Xiaopeng Bai, Eikichi Ihara, Yoshimasa Tanaka, Katsuya Hirano, Mayumi Hirano, Kazuhiko Nakamura

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   31   11 - 11   2016.11

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  • New Approach to Diagnosis and Treatment of Esophageal Motility Disorders by High-Resolution manometry Reviewed

    Eikichi Ihara, Kazumasa Muta, Keita Fukaura, Yoshimasa Tanaka, Xiaopeng Bai, Akira Aso, Tsutomu Iwasa, Kazuhiko Nakamura

    Fukuoka igaku zasshi = Hukuoka acta medica   107 ( 7 )   121 - 130   2016.7

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    Esophageal motility disorders (EMD) is characterized by impaired coordinated esophageal motility function with symptoms including dysphasia, heartburn or noncardiac chest pain. Since EMDs is functional disorders, it is usually difficult to make a diagnosis by conventional examinations including endoscopy and esophagography. Recently developed high-resolution manometry allows us to evaluate esophageal motility function precisely and to make a differential diagnosis of EMDs, together with Chicago Classification (CC) version 3.0 (CC ver3.0). In this article, we reviewed diagnosis of EMDs based on CC ver3.0 and current treatment strategy for EMDs.

  • 高解像度食道内圧検査による食道運動異常症の診断と治療の新展開 Reviewed

    伊原 栄吉, 牟田 和正, 深浦 啓太, 田中 義将, 白 暁鵬, 麻生 暁, 岩佐 勉, 中村 和彦

    福岡医学雑誌   107 ( 7 )   121 - 130   2016.7

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    近年、高解像度食道内圧検査(HRM)が開発され、専門的な測定技術や経験がなくても上部食道括約筋から下部食道括約筋まで連続的に食道運動機能を評価できるようになった。このHRMの登場と共にシカゴ分類が提唱され、食道運動異常症の診断が飛躍的に発展した。最初に食道運動の機序について述べ、次いでHRMによる食道運動異常症のシカゴ分類に基づいた診断法と現状の治療戦略について概説した。

  • Clinical characteristics associated with esophageal motility function Reviewed

    Yoshimasa Tanaka, Eikichi Ihara, Kazuhiko Nakamura, Kazumasa Muta, Keita Fukaura, Koji Mukai, Xiaopeng Bai, Ryoichi Takayanagi

    Journal of Gastroenterology and Hepatology (Australia)   31 ( 6 )   1133 - 1140   2016.6

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    Background and Aim:: Esophageal motility disorders (EMDs) affect coordinated esophageal contractility. Recent developments in high-resolution manometry have improved diagnosis of EMDs; however, the etiology of EMDs remains to be determined. This study aimed to determine which clinical characteristics are associated with esophageal motility. Methods:: From May 2013 to July 2014, 97 patients (54 women, 43 men; age, 16-89years) with suspected EMDs were assessed by high-resolution manometry in Kyushu University Hospital. Esophageal motility was evaluated by measuring the distal contractile integral (DCI), basal lower esophageal sphincter pressure, and integrated relaxation pressure (IRP). Data on age, gender, body mass index (BMI), Brinkman Index, and blood tests were retrospectively collected and analyzed. Results:: Fifty patients were diagnosed as normal, nine with achalasia, twelve with esophagogastric junction outflow obstruction, four with distal esophageal spasm, one with jackhammer esophagus, six with absent peristalsis, ten with frequent failed peristalsis, and five with weak peristalsis. The median DCI was 1229.0mmHg-s-cm, the median basal lower esophageal sphincter pressure was 25.3mmHg, and the median IRP was 9.6mmHg. Patients with major motility disorders were excluded from analysis. By multivariate regression analysis, BMI (P=0.029) and total cholesterol (P=0.023) were negatively associated with DCI, while BMI (P=0.007) was negatively associated with IRP and glucose (P=0.044) was positively associated with IRP. Conclusions:: Both BMI and total cholesterol could be highly predictive factors for esophageal body contractility, while BMI and glucose could be predictive factors for lower esophageal sphincter contractile function.

    DOI: 10.1111/jgh.13262

  • Involvement of Different Subtypes of Receptor in Prostaglandin E2-Induced Motile Function in Lower Esophageal Sphincter and Esophageal Body Smooth Muscle

    Xiaopeng Bai, Eikichi Ihara, Yoshimasa Tanaka, Katsuya Hirano, Mayumi Hirano, Kazuhiko Nakamura

    GASTROENTEROLOGY   150 ( 4 )   S458 - S458   2016.4

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  • Trypsin Induced a Transient Contraction via a PAR2/TRPV1/Neurokinin Receptors Pathway in Circular Smooth Muscle of Porcine Esophageal Body

    Xiaopeng Bai, Eikichi Ihara, Yoshimasa Tanaka, Katsuya Hirano, Mayumi Hirano, Hirotada Akiho, Kazuhiko Nakamura

    GASTROENTEROLOGY   150 ( 4 )   S458 - S458   2016.4

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  • Protease-Activated Receptor Expression in the Esophagus Is Associated With Esophageal Mucosal Integrity and Esophageal Motility Function

    Eikichi Ihara, Keita Fukaura, Kazumasa Muta, Yoshimasa Tanaka, Xiaopeng Bai, Tsutomu Iwasa, Akira Aso, Hirotada Akiho, Kazuhiko Nakamura

    GASTROENTEROLOGY   150 ( 4 )   S43 - S44   2016.4

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    DOI: 10.1016/S0016-5085(16)30272-4

  • Mechanisms of Acotiamide-Sensitive Impaired Lower Esophageal Sphincter Accommodation in Patients With Esophagogastric Junction Outflow Obstruction

    Kazumasa Muta, Eikichi Ihara, Keita Fukaura, Xiaopeng Bai, Yoshimasa Tanaka, Osamu Tsuchida, Toshiaki Ochiai, Tsutomu Iwasa, Akira Aso, Kazuhiko Nakamura

    GASTROENTEROLOGY   150 ( 4 )   S468 - S468   2016.4

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    DOI: 10.1016/S0016-5085(16)31612-2

  • Trypsin-induced biphasic regulation of tone in the porcine lower esophageal sphincter Reviewed

    Yoshimasa Tanaka, Eikichi Ihara, Katsuya Hirano, Shunsuke Takahashi, Mayumi Hirano, Kazuhiko Nakamura, Hirotada Akiho, Yoshinao Oda, Ryoichi Takayanagi

    European Journal of Pharmacology   752   97 - 105   2015.4

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    The lower esophageal sphincter (LES) plays an important role in coordinated esophageal motility. The present study aimed to elucidate how trypsin affects LES contractility. Porcine LES circular smooth muscle strips were prepared. Contractile responses to trypsin were assessed. Trypsin (300 nM) induced a transient contraction. At concentrations of 1 μM or higher, trypsin induced biphasic responses, consisting of a transient contraction followed by a transient relaxation. Pretreatment with either 1 μM tetrodotoxin or carbenoxolone had no effect on these responses. In contrast, trypsin-induced responses were completely blocked by pretreatment with the serine protease inhibitor. Pretreatment with 10 μM FSLLRY-NH2, a PAR2 antagonist, significantly inhibited trypsin-induced biphasic responses. Trypsin (1 μM)-induced contractions were partially inhibited by pretreatment with 10 μM Y-27632. In addition, trypsin (10 μM)-induced relaxation was partially inhibited by pretreatment with 10 μM Y-27632, 10 μM PD98059 or 10 μM SB203580. Trypsin-induced relaxation was abolished by increasing the extracellular K+ concentration to 40 mM, but not by pretreatment with l-arginine methyl ester. Furthermore, trypsin-induced relaxation was partially inhibited by pretreatment with 10 μM glibenclamide or 1 μM 4-aminopyridine. Trypsin causes biphasic regulation of LES tone by directly acting on smooth muscle. Rho-associated protein kinase (ROK) is involved in trypsin-induced contraction, whereas ROK, ERK1/2, p38MAPK, and membrane hyperpolarization are involved in relaxation. The regulation of LES tone by trypsin may play a role in esophageal motility.

    DOI: 10.1016/j.ejphar.2015.02.008

  • The Cytokine Expression Patterns of Esophageal Mucosa Are Associated With Esophageal Motility Function in Human

    Keita Fukaura, Eikichi Ihara, Kazumasa Muta, Yoshimasa Tanaka, Xiaopeng Bai, Kazuhiko Nakamura, Ryoichi Takayanagi

    GASTROENTEROLOGY   148 ( 4 )   S882 - S882   2015.4

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  • Endogenous H2S Contributes to Myogenic Tone Generation in Lower Esophageal Sphincter: Possible Involvement of Na+/CA(2+) Exchanger

    Xiaopeng Bai, Eikichi Ihara, Yoshimasa Tanaka, Katsuya Hirano, Mayumi Hirano, Hirotada Akiho, Kazuhiko Nakamura, Ryoichi Takayanagi

    GASTROENTEROLOGY   148 ( 4 )   S78 - S78   2015.4

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  • Clinical Characteristics Associated With Function of Esophageal Motility: A Retrospective Analysis of 97 Patients

    Yoshimasa Tanaka, Eikichi Ihara, Kazumasa Muta, Keita Fukaura, Koji Mukai, Xiaopeng Bai, Kazuhiko Nakamura, Hirotada Akiho, Ryoichi Takayanagi

    GASTROENTEROLOGY   148 ( 4 )   S818 - S818   2015.4

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  • Acotiamide Has the Potential to Become a Promising Treatment for Patients With Esophagogastric Junction Outflow Obstruction

    Kazumasa Muta, Eikichi Ihara, Keita Fukaura, Xiaopeng Bai, Yoshimasa Tanaka, Kazuhiko Nakamura, Toshiaki Ochiai, Osamu Tsuchida, Hirotada Akiho, Ryoichi Takayanagi

    GASTROENTEROLOGY   148 ( 4 )   S803 - S803   2015.4

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  • Different Contractile and Relaxant Effects of Trypsin in Phasic Smooth Muscles of the Esophageal Body and the Tonic Lower Esophageal Sphincter

    Xiaopeng Bai, Yoshimasa Tanaka, Eikichi Ihara, Katsuya Hirano, Mayumi Hirano, Kazuhiko Nakamura, Hirotada Akiho, Ryoichi Takayanagi

    GASTROENTEROLOGY   146 ( 5 )   S862 - S862   2014.5

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  • Acotiamide, a Novel Prokinetic Drug, Reduces Both Esophageal Body Contractility and the Tone of the Lower Esophageal Sphincter

    Kazumasa Muta, Eikichi Ihara, Xiaopeng Bai, Yoshimasa Tanaka, Kazuhiko Nakamura, Hirotada Akiho, Ryoichi Takayanagi

    GASTROENTEROLOGY   146 ( 5 )   S683 - S683   2014.5

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  • 主リンパ節転移を来した3mm大、回腸原発Neuroendocrine tumorの1例

    徳丸 佳世, 伊原 栄吉, 白 暁鵬, 府川 恭子, 深浦 啓太, 田中 義将, 澤村 紀子, 小森 圭司, 牟田 和正, 小副川 敬, 後藤 綾子, 井星 陽一郎, 岩佐 勉, 中村 和彦, 板場 壮一, 瀧澤 延喜, 平橋 美奈子, 相島 慎一, 小田 義直, 高柳 涼一

    Gastroenterological Endoscopy   56 ( Suppl.1 )   1174 - 1174   2014.4

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  • 難治性GERDの病態解明を目指して ブタ下部食道括約筋と食道体部平滑筋に認めるトリプシン反応性の差異とその生理的意義

    伊原 栄吉, 田中 義将, 白 暁鵬, 牟田 和正, 秋穂 裕唯, 中村 和彦, 高柳 涼一

    日本消化器病学会雑誌   111 ( 臨増総会 )   A252 - A252   2014.3

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  • Trypsin Induced BiPhasic Contraction and Relaxation in the Porcine Lower Esophageal Sphincter

    Yoshimasa Tanaka, Eikichi Ihara, Katsuya Hirano, Mayumi Hirano, Kazuhiko Nakamura, Hirotada Akiho, Ryoichi Takayanagi

    GASTROENTEROLOGY   144 ( 5 )   S857 - S857   2013.5

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  • Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography Reviewed

    Takashi Osoegawa, Yasuaki Motomura, Kazuya Akahoshi, Naomi Higuchi, Yoshimasa Tanaka, Terumasa Hisano, Souichi Itaba, Junya Gibo, Mariko Yamada, Masaru Kubokawa, Yorinobu Sumida, Hirotada Akiho, Eikichi Ihara, Kazuhiko Nakamura

    World Journal of Gastroenterology   18 ( 46 )   6843 - 6849   2012.12

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    AIM: To investigate the clinical outcome of double balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) in patients with altered gastrointestinal anatomy. METHODS: Between September 2006 and April 2011, 47 procedures of DB-ERCP were performed in 28 patients with a Roux-en-Y total gastrectomy (n = 11), Billroth II gastrectomy (n = 15), or Roux-en-Y anastomosis with hepaticojejunostomy (n = 2). DB-ERCP was performed using a short-type DBE combined with several technical innovations such as using an endoscope attachment, marking by submucosal tattooing, selectively applying contrast medium, and CO2 insufflations. RESULTS: The papilla of Vater or hepaticojejunostomy site was reached in its entirety with a 96&#37; success rate (45/47 procedures). There were no significant differences in the success rate of reaching the blind end with a DBE among Roux-en-Y total gastrectomy (96&#37;), Billroth II reconstruction (94&#37;), or pancreatoduodenectomy (100&#37;), respectively (P = 0.91). The total successful rate of cannulation and contrast enhancement of the target bile duct in patients whom the blind end was reached with a DBE was 40/45 procedures (89&#37;). Again, there were no significant differences in the success rate of cannulation and contrast enhancement of the target bile duct with a DBE among Roux-en-Y total gastrectomy (88&#37;), Billroth II reconstruction (89&#37;), or pancreatoduodenectomy (100&#37;), respectively (P = 0.67). Treatment was achieved in all 40 procedures (100&#37;) in patients whom the contrast enhancement of the bile duct was successful. Common endoscopic treatments were endoscopic biliary drainage (24 procedures) and extraction of stones (14 procedures). Biliary drainage was done by placement of plastic stents. Stones extraction was done by lithotomy with the mechanical lithotripter followed by extraction with a basket or by the balloon pull-through method. Endoscopic sphincterotomy was performed in 14 procedures with a needle precutting knife using a guidewire. The mean total duration of the procedure was 93.6 ± 6.8 min and the mean time required to reach the papilla was 30.5 ± 3.7 min. The mean time required to reach the papilla tended to be shorter in Billroth II reconstruction (20.9 ± 5.8 min) than that in Roux-en-Y total gastrectomy (37.1 ± 4.9 min) but there was no significant difference (P = 0.09). A major complication occurred in one patient (3.5&#37;); perforation of the long limb in a patient with Billroth II anastomosis. CONCLUSION: Short-type DBE combined with several technical innovations enabled us to perform ERCP in most patients with altered gastrointestinal anatomy.

    DOI: 10.3748/wjg.v18.i46.6843

  • Characteristics of hemorrhagic peptic ulcers in patients receiving antithrombotic/nonsteroidal antiinflammatory drug therapy Reviewed

    Kazuhiko Nakamura, Kazuya Akahoshi, Toshiaki Ochiai, Keishi Komori, Kazuhiro Haraguchi, Munehiro Tanaka, Norimoto Nakamura, Yoshimasa Tanaka, Kana Kakigao, Haruei Ogino, Eikichi Ihara, Hirotada Akiho, Yasuaki Motomura, Teppei Kabemura, Naohiko Harada, Yoshiharu Chijiiwa, Tetsuhide Ito, Ryoichi Takayanagi

    Gut and Liver   6 ( 4 )   423 - 426   2012.10

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    Background/Aims: Antithrombotic/nonsteroidal antiinflammatory drug (NSAID) therapies increase the incidence of upper gastrointestinal bleeding. The features of hemorrhagic peptic ulcer disease in patients receiving antithrombotic/NSAID therapies were investigated. Methods: We investigated the medical records of 485 consecutive patients who underwent esophagogastroduodenoscopy and were diagnosed with hemorrhagic gastroduodenal ulcers. The patients treated with antithrombotic agents/NSAIDs were categorized as the antithrombotic therapy (AT) group (n=213). The patients who were not treated with antithrombotics/NSAIDs were categorized as the control (C) group (n=263). The clinical characteristics were compared between the groups. Results: The patients in the AT group were significantly older than those in the C group (p<0.0001). The hemoglobin levels before/without transfusion were significantly lower in the AT group (8.24±2.41 g/dL) than in the C group (9.44±2.95 g/dL) (p<0.0001). After adjusting for age, the difference in the hemoglobin levels between the two groups remained significant (p=0.0334). The transfusion rates were significantly higher in the AT group than in the C group (p=0.0002). However, the outcome of endoscopic hemostasis was similar in the AT and C groups. Conclusions: Patients with hemorrhagic peptic ulcers receiving antithrombotic/NSAID therapies were exposed to a greater risk of severe bleeding that required transfusion but were still treatable by endoscopy.

    DOI: 10.5009/gnl.2012.6.4.423

  • Predictive factors for colonic diverticular rebleeding A retrospective analysis of the clinical and colonoscopic features of 111 patients Reviewed

    Yoshimasa Tanaka, Yasuaki Motomura, Kazuya Akahoshi, Risa Iwao, Keishi Komori, Naotaka Nakama, Takashi Osoegawa, Soichi Itaba, Masaru Kubokawa, Terumasa Hisano, Eikichi Ihara, Kazuhiko Nakamura, Ryoichi Takayanagi

    Gut and Liver   6 ( 3 )   334 - 338   2012.7

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    Background/Aims: Colonic diverticular bleeding can stop spontaneously or be stopped by endoscopic hemostasis. We analyzed the clinical and colonoscopic features of patients with colonic diverticular bleeding to establish the predictive factors for rebleeding. Methods: A total of 111 patients (median age, 72 years) with colonic diverticular bleeding in Aso Iizuka Hospital between April 2007 and July 2010 were enrolled. Age, sex, body mass index (BMI), comorbidity, medication, location of bleeding, colonoscopic findings and hemostatic methods were analyzed retrospectively from the hospital records. Results: The most common sites of bleeding were the ascending (39.6&#37;) and sigmoid (29.7&#37;) colon. Overt rebleeding occurred in 30 patients (27.0&#37;). Spontaneous hemostasis was seen in 81 patients (73.0&#37;), and endoscopic hemostatic treatment was performed in 30 patients. The BMI in the patients with colonic diverticular rebleeding was significantly higher than in patients without rebleeding. Colonoscopic findings of actively bleeding or nonbleeding visible vessels in the responsible diverticula were more frequent in the group with rebleeding. Conclusions: A higher BMI and colonoscopic findings of actively bleeding or nonbleeding visible vessels can be used as predictive factors for colonic diverticular rebleeding. Patients with such findings should be carefully followed up after hemostasis of the initial colonic diverticular bleeding.

    DOI: 10.5009/gnl.2012.6.3.334

  • Pretherapeutic evaluation of buried bumper syndrome by endoscopic ultrasonography Reviewed

    Y. Tanaka, K. Akahoshi, Y. Motomura, T. Osoegawa, T. Yukaya, E. Ihara, R. Iwao, K. Komori, N. Nakama, S. Itaba, M. Kubokawa, T. Hisano, K. Nakamura

    Endoscopy   44 ( SUPPL. 2 )   E162   2012.5

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    DOI: 10.1055/s-0031-1291715

  • UGISMTマネージメントにおけるEUS-FNAの臨床的有用性の検討

    麻生 暁, 久保 宏明, 中村 和彦, 澤村 紀子, 深浦 啓太, 田中 義将, 小副川 敬, 井星 陽一郎, 岩佐 勉, 荻野 治栄, 伊原 栄吉, 高柳 涼一, 長田 美佳子, 小田 義直

    Gastroenterological Endoscopy   54 ( Suppl.1 )   1250 - 1250   2012.4

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  • Hepatopancreatobiliary manifestations of inflammatory bowel disease Reviewed

    Kazuhiko Nakamura, Tetsuhide Ito, Kazuhiro Kotoh, Eikichi Ihara, Haruei Ogino, Tsutomu Iwasa, Yoshimasa Tanaka, Yoichiro Iboshi, Ryoichi Takayanagi

    Clinical Journal of Gastroenterology   5 ( 1 )   1 - 8   2012.2

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    Inflammatory bowel disease (IBD) is frequently associated with extraintestinal manifestations such as hepatopancreatobiliary manifestations (HPBMs), which include primary sclerosing cholangitis (PSC), pancreatitis, and cholelithiasis. PSC is correlated with IBD, particularly ulcerative colitis (UC); 70-80&#37; of PSC patients in Western countries and 20-30&#37; in Japan have comorbid UC. Therefore, patients diagnosed with PSC should be screened for UC by total colonoscopy. While symptoms of PSC-associated UC are usually milder than PSC-negative UC, these patients have a higher risk of colorectal cancer, particularly in the proximal colon. Therefore, regular colonoscopy surveillance is required regardless of UC symptoms. Administration of 5-aminosalicylic acid or ursodeoxycholic acid may prevent colorectal cancer and cholangiocarcinoma. While PSC is diagnosed by diffuse multifocal strictures on cholangiography, it must be carefully differentiated from immunoglobulin G4 (IgG4)-associated cholangitis, which shows a similar cholangiogram but requires different treatment. When PSC is suspected despite a normal cholangiogram, the patient may have small-duct PSC, which requires a liver biopsy. IBD patients have a high incidence of acute and chronic pancreatitis. Most cases are induced by cholelithiasis or medication, although some patients may have autoimmune pancreatitis (AIP), most commonly type 2 without elevation of serum IgG4. AIP should be accurately identified based on characteristic image findings, because AIP responds well to corticosteroids. Crohn's disease is frequently associated with gallstones, and several risk factors are indicated. HPBMs may influence the management of IBD, therefore, accurate diagnosis and an appropriate therapeutic strategy are important, as treatment depends upon the type of HPBM.

    DOI: 10.1007/s12328-011-0282-1

  • A case of rectal implantation cyst diagnosed by EUS and EUS-guided FNA Reviewed

    Soichi Itaba, Kazuya Akahoshi, Yasuaki Motomura, Risa Iwao, Yoshimasa Tanaka, Keishi Komori, Takashi Osoegawa, Masaru Kubokawa, Terumasa Hisano, Hiroshi Matono, Masafumi Oya, Kazuhiko Nakamura

    Journal of Japanese Society of Gastroenterology   108 ( 12 )   2030 - 2035   2011.12

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    A 73-year-old woman was referred to our hospital complaining of bloody stool. She had undergone high anterior resection with the double stapling technique for a sigmoid colon cancer 2 years prior to this admission. Colonoscopy revealed a soft submucosal tumor, 4cm in size, on the anal side of the previous anastomosis in the rectum. EUS revealed a cystic lesion located in the third and fourth layers of the rectal wall. EUS-FNA was performed, and the content of the cystic lesion was transparent mucinous liquid. Histologically, the specimen revealed PAS and Alcian blue-positive mucinous material and a small number of inflammatory cells such as foamy macrophages. Therefore, this cystic lesion was diagnosed as a rectal implantation cyst.

  • ENDOSCOPIC SUBMUCOSAL DISSECTION USING A GRASPING-TYPE SCISSORS FORCEPS FOR EARLY GASTRIC CANCERS AND ADENOMAS Reviewed

    AKAHOSHI KAZUYA, HONDA KUNIOMI, MOTOMURA YASUAKI, KUBOKAWA MASARU, OKAMOTO RISA, OSOEGAWA TAKASHI, NAKAMA NAOTAKA, KASHIWABARA YUMI, HIGUCHI NAOMI, TANAKA YOSHIMASA, OYA MASAFUMI, NAKAMURA KAZUHIKO

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   23 ( 1 )   24 - 29   2011.1

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    Endoscopic submucosal dissection using a grasping-type scissors forceps for early gastric cancers and adenomas
    Aim: To reduce the risk of complications related to endoscopic submucosal dissection (ESD) using knives, we developed a new grasping-type scissors forceps (GSF) that can grasp and incise the target tissue using electrosurgical current. The aim of the present study was to evaluate the efficacy and safety of ESD using GSF for the removal of early gastric cancers and adenomas. Methods: ESD using GSF was carried out on 35 consecutive patients with early gastric cancers or adenomas who had preoperative EUS diagnoses of mucosal tumor without lymph node involvement. Therapeutic efficacy and safety were assessed. Results: All lesions were treated easily and safely without unexpected incision. The mean size of epithelial tumors and resected specimens was 15.6 mm and 32.7 mm, respectively. Curative en-bloc resection rates according to tumor size and location were 96&#37; (26/27) in tumors ≤20 mm, 100&#37; (8/8) in tumors >20 mm, 100&#37; (18/18) of tumors in the lower portion, 100&#37; (8/8) of tumors in the middle portion, 89&#37; (8/9) of tumors in the upper portion, and 97&#37; (34/35) overall. The mean operating time according to tumor size and location was 93.4 min in tumors a;circ20 mm, 140 min in tumors >20 mm, 77.6 min for tumors in the lower portion, 113.4 min for tumors in the middle portion, 148.6 min for tumors in the upper portion, and 104.1 min overall. No intraoperative complication occurred, and postoperative bleeding was seen in 3&#37; (1/35). Conclusions: ESD using GSF allows simple and safe en-bloc resection of early gastric cancer or adenoma irrespective of tumor size and location.

    DOI: 10.1111/j.1443-1661.2010.01037.x

  • Capsule endoscopic detection of bleeding Meckels diverticulum, with capsule retention in the diverticulum Reviewed

    Y. Tanaka, Y. Motomura, K. Akahoshi, N. Nakama, T. Osoegawa, Y. Kashiwabara, T. Chaen, N. Higuchi, M. Kubokawa, K. Nishida, T. Yukaya, M. Oya, K. Nakamura

    Endoscopy   42 ( SUPPL. 2 )   E199 - E200   2010.9

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    DOI: 10.1055/s-0030-1255696

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Presentations

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MISC

  • 【慢性便秘症の診療のポイント】慢性便秘症の病態

    伊原 栄吉, 田中 義将, 竹島 翼, 白 暁鵬, 蓑田 洋介, 荻野 治栄

    臨床消化器内科   40 ( 3 )   291 - 297   2025.2   ISSN:0911-601X

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

    <文献概要>便通に重要な消化管内腔水分調節には,CFTRとClC-2の二つのクロライドチャネルおよび食事に含まれるマグネシウムが中心的な役割を果たす.便通に関与する結腸運動機能には,結腸で作られた便を直腸へ運搬するために必要な高振幅大腸収縮波,起床後反応,食事誘発胃結腸反応がある.消化吸収の役目を担う胆汁酸は,TGR5受容体を刺激し,消化管内腔水分調節と結腸運動を担う.正常な排便には,適切な直腸肛門抑制反射,安静時肛門圧と肛門随意圧,直腸肛門協調運動,および直腸感覚閾値が必要である.上記のいずれかの障害が慢性便秘症の病態に関与する.

  • 【薬剤師の情報福袋 新薬,診療GL,etc詰め合わせ】Pick Up! 注目の診療ガイドライン 新薬続々,便通異常症診 療ガイドライン2023 機能性便秘症と機能性下痢症

    荻野 治栄, 田中 義将, 伊原 栄吉

    薬局   76 ( 1 )   36 - 40   2025.1   ISSN:0044-0035

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    Language:Japanese   Publisher:(株)南山堂  

    <文献概要>Key Points 便通異常は,日常生活の質を落とすだけでなく,長期予後にも影響するため適切な治療介入が必要である.機能性便秘症の治療では,刺激性下剤の依存をなくし,緩下剤や上皮機能変容薬,胆汁酸トランスポーター阻害薬などでコントロールすることが大切である.慢性下痢症に占める機能性下痢症の割合は小さいため,慢性下痢症の診療に際しては,二次性の慢性下痢症を鑑別することが大切となる.

  • Efficacy and technical feasibility of a novel endoscopic hand-suturing technique for gastric mucosal defects

    Yosuke Minoda, Yusuke Suzuki, Masafumi Wada, Yoshitaka Hata, Yoshimasa Tanaka, Haruei Ogino, Eikichi Ihara

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   39   72 - 72   2024.11   ISSN:0815-9319 eISSN:1440-1746

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  • 診療ガイドラインat a glance 便通異常症診療ガイドライン2023(慢性便秘症・慢性下痢症)

    伊原 栄吉, 田中 義将, 荻野 治栄

    日本内科学会雑誌   113 ( 10 )   1948 - 1954   2024.10   ISSN:0021-5384

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  • 【食道運動障害の診断と治療】食道運動障害の病態評価に対する新たな試み

    水流 大尭, 牟田 和正, 和田 将史, 畑 佳孝, 蓑田 洋介, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    胃と腸   59 ( 9 )   1273 - 1278   2024.9   ISSN:0536-2180

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    Language:Japanese   Publisher:(株)医学書院  

    <文献概要>はじめに 上部食道括約筋(upper esophageal sphincter;UES)から下部食道括約筋(lower esophageal sphincter;LES)の食道運動をリアルタイムに可視化する高解像度食道内圧検査(high-resolution manometry;HRM)の登場とその診断基準であるシカゴ分類の確立によって,食道運動の機能評価法は発展を遂げた.しかし,HRMとシカゴ分類では評価困難な食道運動障害(esophageal motility disorders;EMDs)が存在し,その原因として注目されるのが食道伸展性(拡張性)と伸展刺激で誘発される二次蠕動である.本稿では食道伸展性の評価法と二次蠕動に注目し解説する.

  • 【今この研究が面白い!】(第6章)消化管 便秘 腸内細菌と腸管運動機能 a role of microbes in gut motility

    白 暁鵬, 田中 義将, 伊原 栄吉

    内科   134 ( 3 )   603 - 606   2024.9   ISSN:0022-1961

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    Language:Japanese   Publisher:(株)南江堂  

    <文献概要>・われわれは慢性便秘症の病態解明と新規治療法の開発を目指し,腸内細菌が腸管運動機能に及ぼす影響とその機序について基礎およびトランスレーショナル研究を行っている.・単一菌種を定着させたノトバイオート動物モデルを用いて,腸内細菌が宿主自然免疫反応を介し,小腸筋間神経叢の血管作動性腸管ペプチド(VIP)神経の発現調節が腸管運動機能の発達・維持に重要な役割を果たすことを解明した.・慢性便秘症患者より採取した糞便を移植して作製したマウスモデルを解析したところ,慢性便秘症患者から採取した腸内細菌が大腸筋間神経叢に炎症性マクロファージを増加させ,Cajal介在細胞(ICC)のネットワーク障害をきたし,大腸運動低下に至る経路を見出した.

  • 【食道運動障害の診断と治療】食道運動障害のX線診断

    畑 佳孝, 水流 大尭, 和田 将史, 蓑田 洋介, 白 暁鵬, 田中 義将, 荻野 治栄, 伊原 栄吉

    胃と腸   59 ( 9 )   1219 - 1228   2024.9   ISSN:0536-2180

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    Language:Japanese   Publisher:(株)医学書院  

    <文献概要>●高解像度食道内圧検査(HRM)の開発と食道運動障害の国際分類であるシカゴ分類が提唱されたことで,食道運動障害(EMD)の診療が飛躍的に発展した.EMD診断のゴールドスタンダードはHRMとなったが,いまだ検査可能な施設は限られており,日常診療におけるEMDの拾い上げ検査として食道X線造影検査にかかる期待は大きい.本稿では古典的食道X線所見(正常,数珠様・コークスクリュー様,無蠕動・微弱蠕動)に加えて,筆者らが新規に提唱する波様,下部食道バルーニングも含めた各食道X線所見について解説した.これらの食道X線所見を用いることで,EMDの拾い上げに対する食道X線造影検査の感度(79.4%)と特異度(88%)は満足な結果であった.食道X線造影検査のみでHRMに基づくEMDの確定診断を行うことは困難であるが,日常診療におけるEMD拾い上げ検査としては,食道X線造影検査は有用な検査として位置付けられる.

  • 【GERD診療Update 2023】食道運動機能障害に起因するGERDと関連諸疾患の鑑別

    畑 佳孝, 和田 将史, 水流 大尭, 田中 義将, 荻野 治栄, 伊原 栄吉

    臨床消化器内科   38 ( 9 )   1201 - 1209   2023.7   ISSN:0911-601X

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    <文献概要>胃食道逆流症(GERD)は「胃内容物の逆流により,不快な症状あるいは合併症を生じた状態」と定義される.日常診療で遭遇する,症状のみで食道粘膜傷害のない非びらん性逆流症(NERD)には,GERD以外の病態が紛れ込む.NERDと鑑別すべき重要な病態に食道運動機能障害(EMDs)があるが,EMDsの一つである無蠕動は高頻度にGERDを合併するため,疾患の理解を複雑化させている.最近,食道生理機能検査の発展に基づいてGERDの病態,鑑別疾患の理解が飛躍的に進歩した.本稿では,EMDsに起因するGERDと鑑別すべき関連諸疾患について概説する.治療抵抗性GERDに遭遇した際には食道生理機能検査を行い,機能性食道疾患,食道運動機能障害,行動障害などの鑑別を行うことが重要である.

  • 【GERDを極める】病態と診断 非びらん性胃食道逆流症の病態と鑑別診断

    伊原 栄吉, 水流 大尭, 和田 将史, 畑 佳孝, 白 暁鵬, 田中 義将, 蓑田 洋介, 江崎 充, 荻野 治栄

    消化器内視鏡   35 ( 5 )   607 - 614   2023.5   ISSN:0915-3217

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  • 【機能性消化管疾患-過敏性腸症候群と慢性便秘症診療の最前線】過敏性腸症候群の病態に応じた段階的治療戦略

    田中 義将, 荻野 治栄, 伊原 栄吉

    日本消化器病学会雑誌   120 ( 3 )   218 - 230   2023.3   ISSN:0446-6586

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    過敏性腸症候群の治療は食事と生活習慣を指導した後に,薬物療法の第1段階として消化管主体の治療を行う.第1選択薬として消化管運動機能調節薬,プロバイオティクス,高分子重合体を使用する.また,IBS分類に応じて下痢型には5-HT3拮抗薬,便秘型には粘膜上皮機能変容薬を投与する.症状の改善が不十分な場合は,優勢な症状に対して止痢薬,抗コリン薬,5-HT4刺激薬,下剤を追加する.さらに,漢方薬,抗アレルギー薬,胆汁酸関連薬や抗菌薬を考慮する.これらの薬物療法が無効な場合,第2段階として抗うつ薬,抗不安薬を用いた中枢機能の調整を含む治療を考慮する.さらに改善が得られない場合,心理療法を考慮する.(著者抄録)

  • 【特殊状況下でのIBD診療を身につける!】担癌患者のIBD診療を身につける

    荻野 治栄, 田中 義将, 知念 孝敏, 伊原 栄吉

    IBD Research   17 ( 1 )   20 - 27   2023.3   ISSN:1881-6533

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    近年では,高齢炎症性腸疾患(IBD)患者が増え,悪性腫瘍の併存や既往があるIBD患者を診療する機会が増加している.IBD診療ではJAK阻害薬など多くの新規治療薬が使用可能となり,また悪性腫瘍の診療では免疫チェックポイント阻害薬の適応が広がっている.そのため,IBD治療の中止や継続,免疫チェックポイント阻害薬の使用の有無について,しばしば難しい判断が要求される.担癌・既往患者のIBD診療にて治療方針を決めるためには,IBD自体のリスクや治療薬のリスク,悪性腫瘍の治療について理解しておく必要がある.しかし,チオプリンや抗TNFα抗体製剤では長期のエビデンスが豊富であるものの,人種差の問題,さらに抗インテグリン抗体や抗IL12/23 p40抗体,JAK阻害薬における長期エビデンスの不足などまだまだ解決すべき点が多い.本稿は,現在報告されているエビデンスを中心に解説しており,今後の診療の一助となれば幸いである.(著者抄録)

  • 【高齢者の消化器疾患-最新の診断と治療-】高齢者における慢性便秘症の診断と治療

    伊原 栄吉, 田中 義将, 荻野 治栄

    日本臨床   81 ( 2 )   242 - 249   2023.2   ISSN:0047-1852

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Professional Memberships

Committee Memberships

  • 日本消化器病学会   Councilor   Domestic

    2020.1 - 2024.5   

  • 日本消化器内視鏡学会   Councilor   Domestic

    2019.5 - 2024.5   

Research Projects

  • 直腸知覚による脳排便中枢を介した排便機構の解明

    2023 - 2027

    AMED・革新的先端研究開発支援事業(PRIME)

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    Authorship:Principal investigator  Grant type:Contract research

  • 慢性便秘症に対する新規治療開発を目指した排便機構の解明

    Grant number:23K15073  2023 - 2025

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Early-Career Scientists

    田中 義将

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    Authorship:Principal investigator  Grant type:Scientific research funding

    排便は、直腸による糞便の感知、便意出現、肛門括約筋弛緩そして直腸収縮といった一連の神経活動の協調的連動によって達成されるが、これまで排便中枢神経回路の分子基盤の解明は非特異的な電気刺激や薬物投与による手法を用いた研究にとどまっており詳細は不明である。
    本研究は排便中枢の局在および役割を明らかにするとともに、新たな便秘治療選択肢を創造する研究である。

    CiNii Research

  • Identification and role of defecation centers using optogenetics and retrograde tracer

    Grant number:20K17054  2020 - 2022

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Early-Career Scientists

    Tanaka Yoshimasa

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    Although the localization and role of the defecation center in the brain have been studied using retrograde tracers, the functional role of the defecation center has not been elucidated in detail due to the technical limitations of electrical and pharmacological stimulation. In this study, by using retrograde tracers and newly developed optogenetics, we were able to specifically manipulate the defecation center candidates and elucidate part of the mechanism that causes defecation.

    CiNii Research

  • ブタLESにおいて神経型ニコチン受容体刺激が引き起こす弛緩反応の機序

    2020 - 2022

    成人病の病因・病態の解明に関する研究助成

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    Authorship:Principal investigator  Grant type:Contract research

Class subject

  • 3学年系統医学II「消化管・腹膜」

    2024.10 - 2025.3   Second semester

  • 3学年系統医学II「消化管・腹膜」

    2023.10 - 2024.3   Second semester

  • 3学年系統医学II「消化管・腹膜」

    2022.10 - 2023.3   Second semester

  • 3学年系統医学II「消化管・腹膜」

    2021.10 - 2022.3   Second semester

  • 3学年系統医学II「消化管・腹膜」

    2020.10 - 2021.3   Second semester

Year of medical license acquisition

  • 2007