記述言語：英語  

DOI： 10.1055/a-2467-9140

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PubMed

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203803

CiNii Research

出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000001751

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203738

CiNii Research

記述言語：英語   出版者・発行元：Digestive and Liver Disease  

DOI： 10.1016/j.dld.2024.07.003

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PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   出版者・発行元：Journal of Gastroenterology  

Background: Spermidine suppress oxidative stress and is involved in various disease pathogenesis including ulcerative colitis (UC). Arginase 2 (ARG2) plays a central role in the synthesis of spermidine. This study aimed to clarify the effect of endogenously produced spermidine on colitis. Methods: The physiological role of ARG2 and spermidine was investigated using Arg2-deficient mice with reduced spermidine. Immunohistochemical staining of the rectum was used to analyze ARG2 expression and spermidine levels in healthy controls and UC patients. Results: In mice with dextran sulfate sodium-induced colitis, ARG2 and spermidine levels were increased in the rectal epithelium. Spermidine protects colonic epithelial cells from oxidative stress and Arg2 knockdown cells reduced antioxidant activity. Organoids cultured from the small intestine and colon of Arg2-deficient mice both were more susceptible to oxidative stress. Colitis was exacerbated in Arg2-deficient mice compared to wild-type mice. Supplementation with spermidine result in comparable severity of colitis in both wild-type and Arg2-deficient mice. In the active phase of UC, rectal ARG2 expression and spermidine accumulation were increased compared to remission. ARG2 and spermidine levels were similar in healthy controls and UC remission patients. Conclusions: ARG2 produces spermidine endogenously in the intestinal epithelium and has a palliative effect on ulcerative colitis. ARG2 and spermidine are potential novel therapeutic targets for UC.

DOI： 10.1007/s00535-024-02104-z

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PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

雌の野生型マウスとArginase 2(ARG2)ノックアウト(KO)マウスを用い、潰瘍性大腸炎(UC)でのARG2とspermidine(SPD)の役割を検討した。Dextran sulfate sodium腸炎を惹起させた大腸炎マウスでは、直腸上皮のARG2値とSPD濃度が上昇していた。酸化ストレス条件下では、ARG2 KOマウスでは野生型マウスと比べて大腸炎が悪化していたが、SPD投与により両者の重症度は同程度となった。また、UC患者の生検検体を調べたところ、活動期UC患者は寛解期UC患者と比べて直腸のARG2発現とSPD蓄積が上方制御されていたが、寛解期UC患者と健常対照者では有意差は認めなかった。以上より、ARG2によって産生されるSPDは抗酸化作用をもち、UCを抑制することが示された。

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203667

CiNii Research

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203673

CiNii Research

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞消化管に虚血による病変を生じるまれな疾患として,クリオグロブリン血症性血管炎を提示する.患者は40歳代,男性.HCV陽性患者で直接作用型抗ウイルス薬による治療中に腹痛を生じ,消化管検査を行った.十二指腸に不整形の潰瘍を複数認め,大腸にはびらんが散見された.小腸には潰瘍や潰瘍瘢痕が観察された.クリオグロブリン弱陽性であり,クリオフィルトレーションと直接作用型抗ウイルス薬による治療を行った.経過中,横行結腸の瘢痕部から血管炎の所見が得られ,クリオグロブリン血症性血管炎と診断した.報告が少ないため消化管病変の特徴は明らかではないが,治療に結び付けるため鑑別診断として考えることは重要である.

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203629

CiNii Research

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞患者は50歳代,女性.上部消化管内視鏡検査で胃底腺領域内に10個前後の発赤調の粘膜下腫瘍(SMT)様隆起があり,背景粘膜は肥厚様であった.SMT様隆起の生検病理検査は神経内分泌腫瘍(NET)の所見であった.血清ガストリンは著増していたが,抗胃壁細胞抗体および抗内因子抗体は陰性,胃以外に内分泌腫瘍を認めなかった.1cm大の2病変に対し,内視鏡的粘膜切除術を施行し,腫瘍部はNET G1であり,病理組織学的に背景粘膜の胃底腺に過形成性変化を認めた.後日,プロトンポンプのαサブユニットをコードするATP4A遺伝子に病的バリアントを認めることが判明し,胃壁細胞機能不全を原因とするIV型胃NETと診断した.

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203560

CiNii Research

出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000001383

CiNii Research

出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000001352

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

小腸カプセル内視鏡(CE)画像読影を補助するためのモデリング問題について検討するデータセットおよび対象検出CE人工知能(AI)モデルの作成を試みた。2014年9月から2021年6月までの間に施行した523回の小腸CEから18481枚の画像を抽出した。23033病変の12320枚の画像に対して注解を行い、6161枚の正常画像と組み合わせてデータセットとして、その特徴を解析した。このデータセットに基づいてYOLO v5を用いた対象検出AIモデルを作成し、その検証を行った。データセットで用いた注解項目は12種類で、同一画像に対して複数の注解項目を適用した。1396枚の画像を用いてAIモデルを検証し、全12種類の注解項目の感度は91%で、1375画像が真陽性、659画像が偽陽性、120画像が偽陰性であった。各注解項目のうち、最も感度が高かったのは97%で、受信者動作特性曲線下面積は0.98であったが、注解項目により診断能は異なっていた。以上より、YOLO v5を用いた小腸CEにおける対象検出AIモデルは効果的かつ理解が容易な読影補助となる可能性があることが示唆された。

記述言語：英語   出版者・発行元：Clinical and Experimental Nephrology  

Background: The intestinal microbiome is involved in the pathogenesis of chronic kidney disease (CKD). Despite its importance, the microbiome of the small intestinal mucosa has been little studied due to sampling difficulties, and previous studies have mainly focused on fecal sources for microbiome studies. We aimed to characterize the small intestinal microbiome of CKD patients by studying the microbiome collected from duodenal and fecal samples of CKD patients and healthy controls. Methods: Overall, 28 stage 5 CKD patients and 21 healthy participants were enrolled. Mucosal samples were collected from the deep duodenum during esophagogastroduodenoscopy and fecal samples were also collected. The 16S ribosomal RNA gene sequencing using Qiime2 was used to investigate and compare the microbial structure and metagenomic function of the duodenal and fecal microbiomes. Results: The duodenal flora of CKD patients had decreased alpha diversity compared with the control group. On the basis of taxonomic composition, Veillonella and Prevotella were significantly reduced in the duodenal flora of CKD patients. The tyrosine and tryptophan metabolic pathways were enhanced in the urea toxin-related metabolic pathways based on the Kyoto Encyclopedia of Genes and Genomes database. Conclusion: The small intestinal microbiome in CKD patients is significantly altered, indicating that increased intestinal permeability and production of uremic toxin may occur in the upper small intestine of CKD patients.

DOI： 10.1007/s10157-023-02434-x

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PubMed

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203479

CiNii Research

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203469

CiNii Research

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞患者は70歳代,男性.注腸X線造影検査や大腸内視鏡検査では下部直腸に中心に陥凹を伴った丈の低い隆起性病変を認め,病変右側には一段丈の高い小隆起を伴っていた.NBIや色素拡大観察では病変の大部分を占める丈の低い隆起部で血管や構造不整が目立ち腺癌を疑い,病変右側の小隆起部では血管や構造不整が目立たず腺腫を疑った.一部粘膜下層(SM)浅層浸潤の可能性もあったが,全体的に粘膜内病変と診断し内視鏡的粘膜下層剥離術を施行した.病理組織学的には一部でSM浅層浸潤(400μm)を認めたが大部分が粘膜内にとどまる高分化管状腺癌で,右側の小隆起は低異型度管状腺腫であった.境界部では内視鏡的に両者を明瞭に区別することが可能で,また分子生物学的所見でも腺腫成分のみでNRAS,APCの遺伝子変異を認めたことから,腺腫と腺癌の衝突腫瘍と診断した.

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞過去23年間に当科および関連施設にて診断された大腸の孤立性若年性ポリープ(JP)101例,孤立性PJP(Peutz-Jeghers type polyp)29例,IMGP(inflammatory myoglandular polyp)18例を対象とし,その臨床像,内視鏡像,病理組織像を遡及的に検討した.その結果,JPは平均年齢が低かった.内視鏡所見では,JPはびらん,白苔,白斑,NBI拡大観察下の開大した腺管開口部や疎に分布した腺窩辺縁上皮,細かい血管の増生,色素拡大観察下の星芒状,疎に分布したpitの,PJPは分葉状,NBIや色素拡大観察下の樹枝状構造の,IMGPは白斑,NBI拡大観察下の開大した腺管開口部,細かい血管の増生,色素拡大観察下の星芒状pitの頻度がそれぞれ高かった.以上よりJP,IMGPとPJPは異なる内視鏡像を呈していたが,JPとIMGPの内視鏡像は比較的類似していた.しかしながら,JPはIMGPに比べ,白苔,NBIや色素拡大観察下の疎に分布する腺窩辺縁上皮やpitの頻度が高いことを加味すると鑑別できる可能性があるものと推察する.

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本内科学会  

Objective T helper (Th) cells play a central role in the pathogenesis of ulcerative colitis (UC). The present study analyzed the changes in circulating T cells by administration of ustekinumab (UST), an interleukin-12/ 23p40 antibody. Methods CD4 T cells were isolated from peripheral blood at 0 and 8 weeks after UST treatment, and we analyzed the proportion of CD4 T cells by flow cytometry. Clinical information and laboratory data were obtained at 0, 8, and 16 weeks. Patients We evaluated 13 patients with UC who received UST for the induction of remission between July 2020 and August 2021. Results The median partial Mayo score improved from 4 (1-7) to 0 (0-6) (p<0.001) with UST. Among serological parameters, albumin concentrations, C-reactive protein concentrations, the sedimentation rate, and leucine-rich alpha 2 glycoprotein concentrations showed significant improvement with UST. A flow cytometric analysis of circulating CD4 T cells showed that the percentage of Th17 cells was significantly decreased by UST treatment in all patients (1.85% to 0.98%, p<0.0001). Th1 cells were significantly increased by UST treatment (9.52% to 10.4%, p<0.05), but Th2 and regulatory T cells were not significantly different. The high-Th17 subgroup had a significantly better partial Mayo score than the low-Th17 subgroup at 16 weeks after UST treatment (0 vs. 1, p=0.028). Conclusion Treatment with UST decreases circulating Th17 cells, suggesting that this change may be related to the anti-inflammatory effect of UC.

DOI： 10.2169/internalmedicine.1724-23

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   出版者・発行元：Journal of Gastroenterology and Hepatology Australia  

DOI： 10.1111/jgh.16347

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PubMed

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203432

CiNii Research

記述言語：英語   出版者・発行元：一般社団法人 日本内科学会  

Objective Flares of inflammatory bowel disease (IBD) can occur infrequently after vaccination for coronavirus disease 2019 (COVID-19), although the details of this phenomenon are poorly understood. To clarify the possibility of an unfavorable response in patients with IBD, we investigated IBD-related symptoms during the COVID-19 vaccination. Methods Between October 2021 and February 2022, we obtained the COVID-19 vaccination status of 411 IBD patients who were being treated at our institution. The disease course of IBD after vaccination was investigated in 188 patients with ulcerative colitis (UC) and 119 patients with Crohn’s disease (CD) who had received at least one dose of the vaccine during the clinical remission phase. The baseline characteristics before vaccination were compared between the patients with UC with or without disease flares. Results During the 30-day follow-up period, eight patients with UC (4.3%) and one patient with CD (0.8%) experienced disease flares following vaccination. Disease flares occurred after the first vaccination in six patients and after the second vaccination in three patients. As for the timing of onset of disease flares, eight events (88.9%) occurred within one week of vaccination. Two patients required hospitalization, and one patient with CD required surgery for an intra-abdominal abscess. The baseline characteristics did not significantly differ between patients with UC who experienced flares and those who did not. Conclusion IBD flares following COVID-19 vaccination are rare and vaccination should therefore be recommended for patients with IBD. However, the possibility of disease flares should be considered for approximately one week after each vaccination, especially in patients with UC.

DOI： 10.2169/internalmedicine.2335-23

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本内科学会  

Objective The risk of developing peptic ulcers and gastrointestinal bleeding is high in patients with chronic kidney disease (CKD). Whether or not kidney transplant patients, who are treated with multiple medications, including immunosuppressive drugs, are at an increased risk of developing peptic ulcers is unclear. Methods In this retrospective study, we compared the clinical and endoscopic features of gastroduodenal ulcers between kidney transplant patients and CKD patients. The subjects underwent upper gastrointestinal endoscopy between January 2015 and March 2021. Results Gastroduodenal ulcers were observed more frequently (6.5%) in kidney transplant patients than in CKD patients (2.1%) (p=0.026). Due in part to the lower median age in the kidney transplant ulcer group than in the CKD ulcer group (59 vs. 70 years old, p=0.016), the rates of atrophic gastritis and Helicobacter pylori infection were also lower in the kidney transplant ulcer group than in the CKD ulcer group. Significantly more kidney transplant patients were treated with acid secretion inhibitors than CKD ulcer patients (100% vs. 34.8%, p=0.0005). Peptic ulcers were observed frequently in kidney transplant patients, even though common risk factors for gastroduodenal ulcers other than immunosuppressive drugs were few. All kidney transplant patients were taking immunosuppressive medications, and tacrolimus, mycophenolate mofetil, and methylprednisolone were taken more frequently than others. Conclusion Kidney transplant patients have a high risk of developing gastroduodenal ulcers. All kidney transplant patients take immunosuppressive medications, so there may be an association between immunosuppressive medications and gastroduodenal ulcer development.

DOI： 10.2169/internalmedicine.1508-22

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞●胃神経内分泌腫瘍(NET)は発生環境の違いによりI～III型の3つの亜型に分類される.近年,いずれの亜型とも異なる胃壁細胞の機能不全によるIV型胃NETの症例が報告されている.今回,その臨床的特徴を明らかにすることを目的とした.当科でIV型胃NETと診断した1例とI型胃NETと診断した13例を対象とし,臨床背景,画像所見,採血データおよび内視鏡治療後標本の病理組織学的所見を比較した.IV型胃NET症例では,プロトンポンプのαサブユニットをコードするATP4A遺伝子に複合ヘテロ接合体の病的変異が確認された.IV型胃NET症例では胃底腺領域内に10個程度の発赤調の粘膜下腫瘍様隆起を認めていた.背景粘膜は肥厚様であり,I型胃NETでみられるA型胃炎とは明らかに異なっていた.I型胃NETとの臨床徴候の比較では,発症時年齢やガストリン値はほぼ同等であったが,抗胃壁細胞抗体と抗内因子抗体は陰性であることと,MCVと血清ビタミンB12は正常であることが異なっていた.IV型胃NETは,プロトンポンプの機能不全に起因する遺伝性疾患と考えられ,新規の疾患概念である.

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203400

CiNii Research

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203397

CiNii Research

記述言語：英語   出版者・発行元：Digestive Endoscopy  

DOI： 10.1111/den.14664

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203379

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記述言語：英語   出版者・発行元：Gastrointestinal Endoscopy  

DOI： 10.1016/j.gie.2023.04.2086

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203279

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記述言語：その他   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.gie.2023.01.050

記述言語：その他   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00535-023-02016-4

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞患者は80歳代,女性.腹部造影CT検査で多発する腹腔内リンパ節腫大を指摘され,左鼠径部リンパ節生検でびまん性大細胞型B細胞リンパ腫(DLBCL)と診断された.DLBCLに対して化学療法が施行され寛解となったが,4年目の経過観察目的の画像評価で上部小腸に再発病変を認めた.内視鏡検査では境界が比較的明瞭な全周性の不整形潰瘍を認めたが,潰瘍底の不整は乏しい印象であった.X線造影検査では高度の腸管狭窄を呈するものの,口側腸管の拡張は目立たなかった.腸管穿通による膿瘍形成を合併したこともあり,小腸部分切除術が施行された.病理組織学的には,潰瘍形成部に一致して中型～大型の異型リンパ球の腫瘍性増殖を認め,免疫組織化学染色の結果と併せてactivated B-cell型のDLBCLと診断した.

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203252

CiNii Research

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Abstract

Objectives

Artificial intelligence (AI) may be practical for image classification of small bowel capsule endoscopy (CE). However, creating a functional AI model is challenging. We attempted to create a dataset and an object detection CE AI model to explore modeling problems to assist in reading small bowel CE.

Methods

We extracted 18,481 images from 523 small bowel CE procedures performed at Kyushu University Hospital from September 2014 to June 2021. We annotated 12,320 images with 23,033 disease lesions, combined them with 6161 normal images as the dataset, and examined the characteristics. Based on the dataset, we created an object detection AI model using YOLO v5 and we tested validation.

Results

We annotated the dataset with 12 types of annotations, and multiple annotation types were observed in the same image. We test validated our AI model with 1396 images, and sensitivity for all 12 types of annotations was about 91%, with 1375 true positives, 659 false positives, and 120 false negatives detected. The highest sensitivity for individual annotations was 97%, and the highest area under the receiver operating characteristic curve was 0.98, but the quality of detection varied depending on the specific annotation.

Conclusions

Object detection AI model in small bowel CE using YOLO v5 may provide effective and easy‐to‐understand reading assistance. In this SEE‐AI project, we open our dataset, the weights of the AI model, and a demonstration to experience our AI. We look forward to further improving the AI model in the future.

DOI： 10.1002/deo2.258

記述言語：英語   出版者・発行元：Journal of Gastroenterology and Hepatology Australia  

DOI： 10.1111/jgh.16027

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PubMed

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞患者は10歳代,男性.主訴は腹痛,下痢.大腸内視鏡検査で上行結腸から下行結腸にかけて粘膜浮腫と縦走潰瘍を,S状結腸には小潰瘍から不整形潰瘍を認めた.Crohn病と診断しインフリキシマブを導入し,アザチオプリンの投与を行うものの寛解維持が困難であり,経過観察の大腸内視鏡検査では終末回腸はやや粗そうで,また直腸から連続性に全大腸に粗そう粘膜,びらん,血管透見像の消失を認めた.回腸からの生検では非乾酪性類上皮細胞肉芽腫を,大腸からの生検では炎症細胞浸潤,陰窩炎,陰窩膿瘍および杯細胞の減少を認めた.異時性にCrohn病,潰瘍性大腸炎両者の内視鏡所見を,同時性に両者の病理組織像を認めたことから,IBDUと診断した.青黛の内服投与で寛解導入され,3年後の大腸内視鏡検査では粘膜治癒が確認された.

記述言語：英語   出版者・発行元：Gastrointestinal Endoscopy  

DOI： 10.1016/j.gie.2023.01.032

Scopus

PubMed

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞患者は60歳代,男性.腹部膨満感と粘液便を主訴に前医を受診し,腸間膜脂肪織炎の診断でステロイド治療を受けるも改善なく経過したため,6ヵ月後に当科へ紹介され受診となった.注腸X線造影検査では下行結腸からS状結腸にかけて長い管状狭窄と拡張不良がみられ,遠位大腸に拇指圧痕像を伴っていた.下部消化管内視鏡検査では下行結腸からS状結腸を中心に全周性区域性の潰瘍と内腔の狭小化を認めた.以上の画像所見と緩徐な臨床経過から,静脈性の虚血性腸病変を考え,腹腔鏡補助下Hartmann手術および横行結腸人工肛門造設術を行った.切除標本の病理組織学的所見では,上皮欠損部に一致する粘膜下層および漿膜下の静脈壁に著明な肥厚と内腔の閉塞がみられたことから,IMHMV(idiopathic myointimal hyperplasia of mesenteric veins)と診断した.

記述言語：その他   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.gie.2023.05.058

記述言語：英語   出版者・発行元：American Journal of Gastroenterology  

DOI： 10.14309/ajg.0000000000002175

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：エルゼビア・ジャパン(株)  

口腔扁平上皮癌(OSCC)細胞の増殖、浸潤、転移におけるトロポミオシン(TPM)1の役割をin vitro実験で調べ、TPM1がOSCCのバイオマーカーとして有用か検討した。5種のヒトOSCC細胞株とヒト表皮角化細胞株を実験材料とした。細胞株にTPM1を標的とする低分子干渉RNAをトランスフェクトし各種アッセイを施行した。その結果、OSCC細胞株ではTPM1を抑制することで増殖能、創傷治癒能、遊走能が亢進することが示された。こうした所見から、OSCC患者ではTPM1低発現が癌細胞の浸潤・転移に寄与している可能性があり、そのためTPM1はOSCCの有用なバイオマーカーとして潜在的な能力を秘めていることが示唆された。

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203197

CiNii Research

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203198

CiNii Research

記述言語：その他   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00384-023-04359-z

記述言語：英語   出版者・発行元：Gastrointestinal Endoscopy  

DOI： 10.1016/j.gie.2022.10.030

Web of Science

Scopus

PubMed

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203108

CiNii Research

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Abstract

Background and Aim

The aim of this study was to elucidate the continuous use of antithrombotic medications during the peri‐colorectal endoscopic submucosal dissection (ESD) period.

Methods

This study included 468 patients with colorectal epithelial neoplasms treated by ESD, consisting of 82 under antithrombotic medications and 386 patients without the medications. Among patients taking antithrombotic medications, antithrombotic agents were continued during the peri‐ESD period. Clinical characteristics and adverse events were compared after propensity score matching.

Results

Before and after propensity score matching, post‐colorectal ESD bleeding rate was higher in patients continuing antithrombotic medications (19.5% and 21.6%, respectively) than in those not taking antithrombotic medications (2.9% and 5.4%, respectively). In the Cox regression analysis, continuation of antithrombotic medications was associated with post‐ESD bleeding risk (hazard ratio, 3.73; 95% confidence interval, 1.2–11.6; P < 0.05) compared with patients without antithrombotic therapy. All patients who experienced post‐ESD bleeding were successfully treated by endoscopic hemostasis procedure or conservative therapy.

Conclusions

Continuation of antithrombotic medications during the peri‐colorectal ESD period increases the risk of bleeding. However, the continuation may be acceptable under careful monitoring for post‐ESD bleeding.

DOI： 10.1111/jgh.16149

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞過去13年間に当科および関連施設にて診断された癌併存大腸SSL 17例を対象とし,病理組織学的所見と対比可能であったSSLと癌の領域の内視鏡所見を遡及的に比較検討した.その結果,癌領域はSSL領域に比べ,発赤(癌領域64.7%/SSL領域0%,p<0.05),結節・顆粒状隆起(癌領域64.7%/SSL領域5.9%,p<0.05)が多くみられた.一方でSSL領域の色調は全例で同色調,ないし褪色調を呈した(癌領域35.3%/SSL領域100%,p<0.05).以上より発赤,結節・顆粒状隆起の存在が癌併存SSLにおける癌領域の特徴的な所見であり,癌併存大腸SSLは通常内視鏡で診断できる可能性が示唆された.

記述言語：英語   出版者・発行元：Digestive and Liver Disease  

DOI： 10.1016/j.dld.2022.08.024

Web of Science

Scopus

PubMed

出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000000381

CiNii Research

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403202993

CiNii Research

記述言語：英語   出版者・発行元：Clinical Journal of Gastroenterology  

A 71-year-old man was admitted to our institution complaining of abdominal pain and constipation. Barium enema examination revealed narrowing, cobble stoning, and longitudinal ulcerations in the sigmoid colon and upper rectum. Conventional colonoscopy, magnifying narrow-band imaging endoscopy, and magnifying chromoendoscopy revealed edematous mucosa, longitudinal ulcerations with luminal narrowing, and multiple pseudopolyps. The histologic examination of the biopsy specimens showed thick-walled (arterialized) capillaries and subendothelial fibrin deposits in the mucosa and submucosa. Based on a preoperative diagnosis of idiopathic myointimal hyperplasia of mesenteric veins (IMHMV), he underwent a laparoscopic resection of the sigmoid colon and upper rectum. The histologic examination of the resected specimens showed marked proliferation of venous walls with marked myointimal thickening and luminal occlusion from the submucosa to the mesentery throughout the entire resected tissue section. The final diagnosis was IMHMV.

DOI： 10.1007/s12328-022-01647-z

Web of Science

Scopus

PubMed

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞患者は60歳代,女性.主訴は腹部膨満感,便秘,腹痛,嘔吐.注腸X線造影検査,大腸内視鏡検査で肝彎曲部・横行結腸の狭窄,横行結腸上縁・下行結腸内側を中心に顆粒状粘膜と片側性変形を認めた.上部消化管X線造影検査・内視鏡検査で胃壁の伸展不良を認め,小腸X線造影検査では中部～下部小腸に片側性変形,狭窄を認めた.横行結腸と胃から採取した生検組織の粘膜固有層内に低分化腺癌および印環細胞癌のびまん性増殖がみられ,免疫組織化学染色ではCK(cytokeratin)7陽性,CK20陰性であった.以上より,胃を原発とした低分化腺癌および印環細胞癌が大腸・小腸に転移を来した症例と診断した.

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403202910

CiNii Research

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403202757

CiNii Research

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403202850

CiNii Research

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403202844

CiNii Research

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403202762

CiNii Research

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞過去15年間に当科および関連施設にて診断された原発性空・回腸癌19例を対象とし,臨床像,小腸X線造影所見を検討した.平均腫瘍径は43.4mmで,病変部位は空腸12例,回腸7例であった.肉眼型は潰瘍型が14例と最多で,すべて輪状狭窄型であった.TNM分類Stage IVの割合が高く(32%),5年後のOS(overall survival)は58%,TNM分類Stage IVはOS,EFS(event-free survival)の,空腸,潰瘍型はEFSの予後不良因子であった.小腸X線造影所見では輪状狭窄型の全例,および全周性の隆起型病変でnapkin-ring sign,口側腸管の拡張像を,輪状狭窄型はさらに全例でoverhanging edgeを認めた.以上より,原発性空・回腸癌の予後不良因子はTNM分類Stage IVであり,輪状狭窄型および全周性の隆起型病変は特徴的な小腸X線造影検査所見を有していた.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIMS: Recent studies suggested a favorable effect of indigo naturalis (IN) in inducing remission for refractory ulcerative colitis (UC), however, the maintenance effect of IN for patients with UC remains unknown. Therefore, we conducted a prospective uncontrolled open-label study to analyze the efficacy and safety of IN for patients with UC. METHODS: Patients with moderate to severe active UC (clinical activity index [CAI] ≥ 8) took 2 g/day of IN for 52 weeks. CAI at weeks 0, 4, 8, and 52 and Mayo endoscopic subscore (MES) and Geboes score (GS) at weeks 0, 4, and 52 were assessed. Clinical remission (CAI ≤ 4), mucosal healing (MES ≤ 1), and histological healing (GS ≤ 1) rates at each assessment were evaluated. Overall adverse events (AEs) during study period were also evaluated. The impact of IN on mucosal microbial composition was assessed using 16S ribosomal RNA gene sequences. RESULTS: Thirty-three patients were enrolled. The rates of clinical remission at weeks 4, 8, and 52 were 67%, 76%, and 73%, respectively. The rates of mucosal healing at weeks 4 and 52 were 48% and 70%, respectively. AEs occurred in 17 patients (51.5%) during follow-up. Four patients (12.1%) showed severe AEs, among whom 3 manifested acute colitis. No significant alteration in the mucosal microbial composition was observed with IN treatment. CONCLUSIONS: One-year treatment of moderate to severe UC with IN was effective. IN might be a promising therapeutic option for maintaining remission in UC, although the relatively high rate of AEs should be considered.

DOI： 10.5217/ir.2021.00124

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Introduction: An association has been found between human-gut microbiota and various diseases (e.g., metabolic disease) by analyzing fecal or colonic microbiota. Despite the importance of the small intestinal microbiota, sampling difficulties prevent its full analysis. We investigated the composition and metagenomic functions of microbiota along the small intestine and compared them with the microbiota from feces and from other gastrointestinal (GI) sites. Methods: Mucosal samples from the six GI sites (stomach, duodenum, distal jejunum, proximal ileum, terminal ileum, and rectum) were collected under balloon-assisted enteroscopy. Fecal samples were collected from all participants. The microbial structures and metagenomic functions of the small intestinal mucosal microbiota were compared with those from feces and other GI sites using 16S ribosomal RNA gene sequencing. Results: We analyzed 133 samples from 29 participants. Microbial beta diversity analysis showed that the jejunum and ileum differed significantly from the lower GI tract and the feces (p &#x3c; 0.001). Jejunal and duodenal microbiotas formed similar clusters. Wide clusters spanning the upper and lower GI tracts were observed with the ileal microbiota, which differed significantly from the jejunal microbiota (p &#x3c; 0.001). Veillonella and Streptococcus were abundant in the jejunum but less so in the lower GI tract and feces. The metagenomic functions associated with nutrient metabolism differed significantly between the small intestine and the feces. Conclusions: The fact that the compositional structures of small intestinal microbiota differed from those of fecal and other GI microbiotas reveals that analyzing the small intestinal microbiota is necessary for association studies on metabolic diseases and gut microbiota.

DOI： 10.1159/000524023

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although combining thiopurine with infliximab (IFX) is considered to improve the clinical efficacy of IFX when treating Crohn's disease (CD), it also increases the risk of adverse events (AEs). We compared the efficacy and safety of delayed thiopurine addition after loss of response (LOR) to IFX with the efficacy and safety of an earlier combination of thiopurine and IFX. METHODS: This retrospective study analyzed patients with CD who started IFX as a first-line biologic at Kyushu University Hospital between June 2002 and July 2018. Patients were assigned to either the early-combination (EC) group, who started IFX and thiopurine simultaneously, or the late-combination (LC) group, who were treated with IFX alone until they developed LOR. We compared the cumulative IFX continuation rates and AE incidence between the two groups. RESULTS: One hundred seventy-six patients were enrolled in this study; 49 were enrolled in the EC group, and 127 were enrolled in the LC group. Disease activity at baseline did not significantly differ between the groups, nor did the cumulative IFX continuation rates differ between the groups (P = 0.30); however, the AE rate was significantly higher in the EC group than in the LC group (38.7% vs. 21.2%; P = 0.02). The severe AE rate was also higher in the EC group than in the LC group (18.3% vs 3.1%; P = 0.001). CONCLUSION: Considering the risk-benefit balance, delayed addition of thiopurine after LOR to IFX might be an alternative strategy when using IFX to treat CD.

DOI： 10.1007/s10620-020-06600-z

記述言語：英語   掲載種別：研究論文（学術雑誌）  

ABSTRACT: To investigate the mucosal microbiota in the stomach of patients with Helicobacter pylori-negative mucosa-associated lymphoid tissue (MALT) lymphoma by means of metagenomic analysis.Although some gastric MALT lymphomas are associated with the presence of H. pylori, other gastric MALT lymphomas occur independently of H. pylori infection. The pathogenesis of H. pylori-negative MALT lymphoma remains unclear.Mucosal biopsy specimens were collected from the gastric body from 33 MALT lymphoma patients with gastric lesions, including both H. pylori-infection naïve patients and posteradication patients, as well as 27 control participants without H. pylori infection or cancer. Subsequently, the samples were subjected to 16S rRNA gene sequencing. Quantitative insights into microbial ecology, linear discriminant analysis effect size, and phylogenetic investigation of communities by reconstruction of unobserved states softwares were used to analyze the participants' microbiota.H. pylori-negative MALT lymphoma patients had significantly lower alpha diversity (P = .04), compared with control participants. Significant differences were evident in the microbial composition (P = .04), as determined by comparison of beta diversity between the 2 groups. Taxonomic composition analysis indicated that the genera Burkholderia and Sphingomonas were significantly more abundant in MALT lymphoma patients, while the genera Prevotella and Veillonella were less abundant. Functional microbiota prediction showed that the predicted gene pathways "replication and repair," "translation," and "nucleotide metabolism" were downregulated in MALT lymphoma patients.H. pylori-negative MALT lymphoma patients exhibited altered gastric mucosal microbial compositions, suggesting that altered microbiota might be involved in the pathogenesis of H. pylori-negative MALT lymphoma.

DOI： 10.1097/MD.0000000000027287

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Several adsorptive type devices for ulcerative colitis are used for the induction of remission in patients with active severe disease worldwide. In 2020, the novel apheresis device Immunopure for ulcerative colitis was launched in Japan. Immunopure, like the polyethylene terephthalate column, uses polyarylate, a type of polyester resin, as the adsorbent. Similar to the cellulose acetate column, Immunopure is filled with adsorbent beads and expected to provide ease of use, with minimal risk of column clogging. Immunopure adsorbs leukocytes and platelets, especially activated platelets and platelet-leukocyte aggregates. In this article, the capability of Immunopure is evaluated from clinical perspective based on a clinical trial in Japan/Europe. As a result, Immunopure is comparable to other products in clinical effectiveness and indicated for the treatment of patients with refractory moderate ulcerative colitis, making it highly useful in clinical practice.

DOI： 10.1111/1744-9987.13661

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This study aimed to compare the markers of potential pancreatic injury during antegrade double-balloon endoscopy (DBE) using the newly developed ultrathin EN-580XP system and the conventional EN-580T system. METHODS: Patients who were scheduled for antegrade DBE during daily clinical practice were enrolled. Clinical background, adverse events, and laboratory data of patients were compared between those who underwent endoscopy using the EN-580XP system and those in whom the EN-580T system was used. The primary end points were pancreatic hyperamylasemia and hyperlipasemia after DBE. RESULTS: A total of 295 cases were registered. Pancreatic hyperamylasemia occurred in 2 of 92 patients (2.2 %) in the EN-580XP group and in 28 of 147 patients (19.1 %) in the EN-580 T diagnosis group (P < 0.001). Hyperlipasemia was significantly different between the two groups (1.1 % [EN-580XP] vs. 13.6 % [EN-580 T diagnosis]; P < 0.001). Acute pancreatitis occurred in four patients (7.1 %) in the EN-580 T therapy group. Multiple logistic regression analyses revealed that the endoscope type EN-580 T was significantly associated with pancreatic hyperamylasemia (adjusted odds ratio [OR] 8.63, 95 % confidence interval [CI] 1.97 - 37.70; P < 0.01) and hyperlipasemia (adjusted OR 13.10, 95 %CI 1.70 - 100.70; P = 0.01). CONCLUSIONS: The EN-580XP system seemed less harmful to the pancreas during antegrade DBE.

DOI： 10.1055/a-1243-0226

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Ustekinumab (UST), an antibody targeting the p40 subunit of interleukin (IL)-12 and IL-23, is effective in treating Crohn's disease (CD). To clarify the mechanism of UST, we investigated T-cell differentiation in CD patients treated with UST. METHODS: Twenty-seven patients with active CD were enrolled in this study. Seventeen patients were treated with UST, and 10 patients were treated with anti-tumor necrosis factor (TNF)-alpha therapy. The changes in the proportions of T-cell subsets after these therapies were analyzed by flow cytometry. Comprehensive gene expression changes in the colonic mucosa were also evaluated. RESULTS: The frequency of T helper (Th) 17 cells was significantly decreased in the peripheral blood of patients with active CD after UST therapy. Anti-TNF therapy had a minimal effect on Th17 cells but increased the proportion of regulatory T cells. Enrichment analysis showed the expression of genes involved in the Th17 differentiation pathway was downregulated in the colonic mucosa after UST but not anti-TNF therapy. There were no common differentially expressed genes between CD patients treated with UST and anti-TNF therapy, suggesting a clear difference in their mechanism of action. CONCLUSION: In patients with active CD, UST therapy suppressed Th17 cell differentiation both in the peripheral blood and colonic tissues.

DOI： 10.1159/000518103

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The aim of this investigation was to evaluate the clinical value of barium enema (BE) examination for the management of colorectal epithelial neoplasms. METHODS: We reviewed the colonoscopy records at our institution from 2014 to 2019 and identified cases of endoscopically or surgically resected colorectal epithelial neoplasms evaluated by BE, conventional colonoscopy, magnifying narrow-band imaging colonoscopy (M-NBI), and magnifying chromoendoscopy (MCE). The yield of each modality for the diagnosis of massively submucosal invasive (mSM) colorectal cancer was evaluated by a receiver-operating characteristic analysis including the area under the curve (AUC). RESULTS: We analyzed the records of 105 patients (17 adenomas, 53 high-grade dysplasias (HGDs), and 35 cancers). Smooth surface, irregularity in depression, and eccentric deformity on the profile view with BE were observed more frequently in mSM cancers than adenomas/HGDs/slightly submucosal invasive cancers (p < 0.01). The AUC of BE was 0.8355, the value of which was not different from the other three modalities (conventional colonoscopy 0.7678; M-NBI 0.7835; MCE 0.8376). Although the specificity, PPV, and accuracy of BE were lower than those of M-NBI and MCE, the sensitivity and NPV of BE were the highest among the four types of examinations. CONCLUSION: BE is still available and may serve as a supplementary modality for the diagnosis of mSM cancers.

DOI： 10.1007/s11604-021-01157-x

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: While there is an association between successful eradication of Helicobacter pylori (HP) and reflux esophagitis (RE), risk factors associated with RE remain obscure. The aim of this study is to determine risk factors associated with the development of RE after HP eradication.Materials and methods: Among all patients treated with successful HP eradication from 2008 to 2016, we retrospectively analyzed those who were free from RE at initial esophagogastroduodenoscopy (EGD) and who were followed up with EGD after eradication. Patients were classified according to the presence or absence of RE at the follow-up EGD. RE was defined as mucosal breaks proximal to the squamous-columnar junction. Demographic data, underlying diseases, medications and endoscopic findings at the initial EGD were compared between patients with and without RE.Results: Among 1575 patients, 142 (9.0%) had RE at the follow-up EGD. The time interval from HP eradication until EGD ranged from 4 to 24 months. The endoscopic grade of RE was higher in males than in females. Multivariate analysis revealed that male sex (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.04-2.24), body mass index ≥25 kg/m2 (OR, 2.91; 95% CI, 2.00-4.22), use of calcium channel blockers (OR, 1.70; 95% CI, 1.12-2.55), and hiatal hernia (OR, 3.46; 95% CI, 2.41-5.00) were associated with the development of RE.Conclusions: Calcium channel blocker use was found to be a risk factor for the development of RE after eradication of HP.

DOI： 10.1080/00365521.2019.1671487

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Little is known about the long-term outcomes and prognostic factors with non-curative endoscopic submucosal dissection (ESD) in elderly patients with early gastric cancer. METHODS: Clinicopathological findings and long-term outcomes were evaluated in 87 patients with early gastric cancer (EGC) aged ≥ 75 years who were treated with non-curative ESD. Prognostic factors for overall survival (OS) were analyzed with the Kaplan-Meier method and a Cox proportional hazards model. RESULTS: During the follow-up period, among 27 patients who died of any cause, only one patient died of gastric cancer. OS probabilities after 3 and 5 years were 89.7% and 79.3%, respectively. Univariate analyses revealed that Eastern Cooperative Oncology Group performance status 2-3, Charlson comorbidity index (CCI) ≥ 3, neutrophil/lymphocyte ratio ≥ 3.3, prognostic nutritional index < 44.8, distal tumor location and macroscopically depressed or flat configuration were associated with poor OS. Cox multivariate analysis revealed high CCI (≥ 3) to be an independent prognostic factor associated with OS (hazard ratio: 2.63, 95% confidence interval [CI] 1.06-6.49, P = 0.037). CONCLUSIONS: CCI may be a useful parameter for decision-making regarding additional surgery for elderly patients with gastric cancer treated by non-curative ESD.

DOI： 10.1007/s10120-018-00913-9

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background/Aims: We recently identified recessive mutations in the solute carrier organic anion transporter family member 2A1 gene (SLCO2A1) as causative variants of chronic nonspecific multiple ulcers of the small intestine (chronic enteropathy associated with SLCO2A1, CEAS). The aim of this study was to investigate the gastroduodenal expression of the SLCO2A1 protein in patients with CEAS and Crohn's disease (CD). Methods: Immunohistochemical staining for SLCO2A1 was performed with a polyclonal antibody, HPA013742, on gastroduodenal tissues obtained by endoscopic biopsy from four patients with CEAS and 29 patients with CD. Results: The expression of SLCO2A1 was observed in one of four patients (25%) with CEAS and in all 29 patients (100%) with CD (p<0.001). The three patients with CEAS without SLCO2A1 expression had a homozygous splice-site mutation in SLCO2A1, c.1461+1G>C (exon 7) or c.940+1G>A (exon 10). The remaining one CEAS patient with positive expression of SLCO2A1 had compound heterozygous c.664G>A and c.1807C>T mutations. Conclusions: Immunohistochemical staining for SLCO2A1 in gastroduodenal tissues obtained by endoscopic biopsy is considered useful for the distinction of CEAS from CD.

DOI： 10.5009/gnl18261

記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: The aim of your study is to characterize serrated lesions according to their molecular patterns, specifically BRAF/KRAS mutation, methylation, and microsatellite statuses. We evaluated the molecular patterns of 163 serrated lesions, including 37 microvesicular hyperplastic polyps, 73 sessile serrated adenomas/polyps (SSA/Ps), 31 traditional serrated adenomas, and 22 SSA/Ps with cytological dysplasia/adenocarcinoma. METHODS: Mutations in BRAF (V600E)/KRAS (exon 2) and microsatellite status [microsatellite stability (MSS) vs. MSI] were examined using a pyrosequencer and the PCR-based microsatellite method, respectively. DNA methylation status was classified as low (LME), intermediate (IME), or high methylation epigenotype (HME) according to a PCR-based two-step method. In addition, mucin and annexin A10 expression was examined. Finally, we performed a hierarchical clustering analysis of the BRAF/KRAS mutation, DNA methylation, and microsatellite statuses. RESULTS: The molecular patterns observed in the serrated lesions could be divided into five subgroups: lesions characterized by (1) BRAF mutation, HME, and MSI; (2) BRAF mutation, HME, and MSS; (3) BRAF mutation, LME/IME, and MSS; (4) no BRAF/KRAS mutations, LME/IME, and MSS; and (5) KRAS mutation, LME/IME, and MSS. In addition, we demonstrated that these observed molecular patterns help identify the associations of the molecular patterns and markers (i.e., mucin and annexin A10) with the clinicopathological findings, including histological features and histological diagnosis. CONCLUSIONS: We suggest that the identified molecular patterns play an important role in the pathway of serrated lesion development.

DOI： 10.1007/s10620-018-5167-4

記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To determine appropriate fecal calprotectin cut-off values for the prediction of endoscopic and histologic remission in Japanese patients with ulcerative colitis (UC). METHODS: We performed a cross-sectional observational study of 131 Japanese patients with UC and measured fecal calprotectin levels by fluorescence enzyme immunoassay. The clinical activity of UC was assessed with the partial Mayo score (PMS). Relapse was defined as increase of PMS by 2 points or more in stool frequency or rectal bleeding subscore. The endoscopic and histologic activities of UC were evaluated in 50 patients within a 2-mo period from fecal sampling. Endoscopic activity was determined by Mayo endoscopic subscore, Rachmilewitz endoscopic index, and ulcerative colitis endoscopic index of severity. The histologic grade of inflammation was evaluated with biopsy specimens obtained from the endoscopically most severely inflamed site, according to the scheme by Matts grade and Riley's score. RESULTS: Fecal calprotectin levels varied from 1-20783 μg/g. There was a significant correlation between the partial Mayo score and fecal calprotectin levels (r = 0.548, P < 0.001). In 50 patients who underwent colonoscopy with biopsy, levels were significantly correlated with the Mayo endoscopic subscore (r = 0.574, P < 0.001), Rachmilewitz endoscopic index (r = 0.628, P < 0.001), ulcerative colitis endoscopic index of severity (r = 0.613, P < 0.001), Riley's histologic score (r = 0.400, P = 0.006), and Matts grade (r = 0.586, P < 0.001). Receiver-operating characteristic analyses identified the best cut-off value for the prediction of endoscopic remission as 288 μg/g, with an area under the curve of 0.777 or 0.823, while that for histologic remission was 123 or 125 μg/g, with an AUC of 0.881 or 0918, respectively. Of the 131 study patients, 88 patients in clinical remission were followed up 6 mo. During the follow-up period, 19 patients relapsed. The best fecal calprotectin cut-off value for predicting relapse was 175 μg/g. CONCLUSION: Fecal calprotectin is a predictive biomarker for endoscopic and histologic remission in Japanese patients with UC.

DOI： 10.3748/wjg.v24.i38.4384

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background/Aims: We recently identified recessive mutations in the solute carrier organic anion transporter family member 2A1 gene (SLCO2A1) as causative variants of chronic enteropathy associated with SLCO2A1 (CEAS). The aim of this study was to evaluate SLCO2A1 protein expression in the intestinal tissues of patients with CEAS, intestinal Behçet's disease (BD), simple ulcer (SU), and Crohn's disease (CD). Methods: Immunohistochemical staining using a polyclonal anti-SLCO2A1 antibody was performed on the resected intestinal specimens from 13 cases of CD, 9 cases of intestinal BD/SU, and 3 cases of CEAS. The extent of SLCO2A1 expression was determined by counting positively-staining vascular endothelial cells and scored as 0 (no cells), 1 (1%-30% cells), 2 (31%-60%), or 3 (>60%). The intensity of SLCO2A1 expression was scored either as 0 (negative), 1 (intermediate), or 2 (strong). The extent score and intensity score were summed for the final score of 0, 2, 3, 4, or 5. Results: SLCO2A1 protein expression was observed in 1 of 3 cases of CEAS (33%), all 13 cases of CD (100%), and all 9 cases of BD/SU (100%). The mean final expression scores of CEAS, CD, and BD/SU were 1.6 (range, 0-5), 4.8 (range, 4-5), and 4.3 (range, 4-5), respectively. The final expression score in CEAS was significantly lower than in CD (P=0.03). Conclusions: Immunohistochemical staining of the SLCO2A1 protein is considered useful to distinguish CEAS from other inflammatory bowel diseases.

DOI： 10.5217/ir.2018.16.3.393

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: Recent studies have shown that cancer-associated fibroblasts (CAFs) and the epithelial-mesenchymal transition (EMT) play important roles in the progression and metastasis of CRC. Although prediction of lymph node metastasis in submucosal invasive colorectal cancer (SiCRC) is important, the relationships of CAF and EMT with lymph node metastasis of SiCRC have not yet been examined. Here, we aimed to analyze the expression patterns of CAF- and EMT-related proteins in SiCRC. Materials and Methods: The expression of CAF-related markers, including α-smooth muscle actin, CD10, podoplanin, fibroblast specific protein 1, and adipocyte enhancer-binding protein 1, and EMT-related proteins [zinc finger protein SNAI2 (ZEB1) and twist-related protein 1 (TWIST1) in SiCRC with (n = 29) or without (n = 80) lymph node metastasis was examined by immunohistochemistry. We examined the expression patterns of biomarkers using hierarchical cluster analysis. Consequently, four subgroups were established based on the expression patterns of CAF- and EMT-related markers, and the associations of these subgroups with clinicopathological variables. Results: In multivariate analysis, subgroup 2, which was characterized by high expression of all markers, was correlated with lymph node metastasis (p < 0.01). Next, we examined the associations of individual biomarkers with lymph node metastasis. Multivariate analysis showed that moderately differentiated adenocarcinoma was significantly associated with lymph node metastasis (p < 0.05). Conclusions: Our findings showed that expression patterns of CAF markers and EMT-related proteins may allow for stratification of patients into risk categories for lymph node metastasis in SiCRC.

DOI： 10.7150/jca.25646

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIMS: We aimed to investigate an association between clinicopathological features, including immunohistochemical mucin phenotypes, and magnifying chromoendoscopic findings with crystal violet staining (ME-CV) in non-ampullary duodenal epithelial tumors (NADETs). METHODS: A total of 55 patients with NADET were divided into 3 groups by mucin phenotype: intestinal, gastrointestinal, or gastric. ME-CV findings were classified into 4 patterns: convoluted, leaf-like, reticular/sulciolar, and pinecone. The clinicopathological features and ME-CV findings were compared among the mucin phenotypes. RESULTS: Tumors of the gastric type were located in the duodenal bulb (p < 0.001), and contained pyloric gland adenoma (p < 0.001) more frequently than the other types. White-light endoscopy indicated that milk-white mucosa was less frequent in tumors of the gastric type than in those of the gastrointestinal type (p = 0.006) and the intestinal type (p < 0.001). ME-CV findings were significantly different between the gastric type and the other type (p = 0.028). Totally, 5 of 8 tumors of the gastric type manifested a pinecone pattern, 4 of which were compatible with pyloric gland adenoma. CONCLUSIONS: The endoscopic findings of NADETs differ according to mucin phenotype. A pinecone pattern under ME-CV may be characteristic of NADETs of the gastric type, especially pyloric gland adenoma.

DOI： 10.1159/000485505

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We examined colorectal adenomas and intramucosal adenocarcinomas (IMAs) to develop a genome-wide overview of copy number alterations (CNAs) during colorectal tumorigenesis. METHODS: We analysed CNAs using a high-resolution SNP array of isolated tumour glands obtained from 55 colorectal adenomas (35 low-grade adenomas and 20 high-grade adenomas) and 30 IMAs. Next, we examined whether frequent CNAs differed between low-grade and high-grade adenomas or high-grade adenomas and IMAs. Finally, we investigated the total lengths of the CNAs in low-grade adenomas, high-grade adenomas, and IMAs. RESULTS: Although no frequent CNAs were found in low-grade adenomas, the most frequent alterations of high-grade adenomas were gains of 7q11, 7q21 and 9p13 and loss of 5q14.3-35. High levels of gains were detected at 13q, 7q, 8p, 20q, 7p, 18p and 17p in IMAs. Although no frequent alteration differed between low-grade and high-grade adenomas, significant differences of gains at 13q, 17p and 18p were found between high-grade adenoma and IMAs. Although the total lengths of all CNAs (gains and losses), copy number gains, and losses of heterozygosity were significantly greater in high-grade adenomas than in low-grade adenomas, no significant differences in the lengths of CNAs were found between high-grade adenomas and IMAs. CONCLUSIONS: Genomic alterations play an essential role in early colorectal carcinogenesis. CNAs in colorectal tumours provide new insights for evaluation of colorectal tumorigenesis.

DOI： 10.1007/s00535-017-1317-2

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and study aim Magnifying narrow-band imaging (M-NBI) is useful for the accurate diagnosis of early gastric cancer (EGC). However, acquiring skill at M-NBI diagnosis takes substantial effort. An Internet-based e-learning system to teach endoscopic diagnosis of EGC using M-NBI has been developed. This study evaluated its effectiveness. Participants and methods This study was designed as a multicenter randomized controlled trial. We recruited endoscopists as participants from all over Japan. After completing Test 1, which consisted of M-NBI images of 40 gastric lesions, participants were randomly assigned to the e-learning or non-e-learning groups. Only the e-learning group was allowed to access the e-learning system. After the e-learning period, both groups received Test 2. The analysis set was participants who scored < 80 % accuracy on Test 1. The primary end point was the difference in accuracy between Test 1 and Test 2 for the two groups. Results A total of 395 participants from 77 institutions completed Test 1 (198 in the e-learning group and 197 in the non-e-learning group). After the e-learning period, all 395 completed Test 2. The analysis sets were e-learning group: n = 184; and non-e-learning group: n = 184. The mean Test 1 score was 59.9 % for the e-learning group and 61.7 % for the non-e-learning group. The change in accuracy in Test 2 was significantly higher in the e-learning group than in the non-e-learning group (7.4 points vs. 0.14 points, respectively; P < 0.001). Conclusion This study clearly demonstrated the efficacy of the e-learning system in improving practitioners' capabilities to diagnose EGC using M-NBI.Trial registered at University Hospital Medical Information Network Clinical Trials Registry (UMIN000008569).

DOI： 10.1055/s-0043-111888

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIMS: There has been little information about the long-term outcomes of patients with early gastric cancer (EGC) treated by non-curative endoscopic submucosal dissection (ESD) with negative resected margins (R0 resection). We aimed to compare the clinical outcomes of non-curative ESD with R0 resection between patients who underwent additional gastrectomy and those who did not. METHODS: Among EGC patients treated by ESD from 2002 to 2010, 66 patients were treated by non-curative ESD with R0 resection. Patients received either additional gastrectomy (group A, n = 45) or were followed up without gastrectomy (group B, n = 21). The clinicopathologic findings and the subsequent clinical course were compared between the 2 groups. RESULTS: Patients in group A were younger than those in group B (68.0 vs 71.0 years, P = .006). The follow-up period was longer in group A than in group B (7.8 vs 5.9 years, P = .011). The percentage of patients who died of any cause was not statistically lower in group A than in group B (13.3% vs 33.3%, P = .06). Although the overall survival rate was higher in group A than in group B (93.3% vs 76.2%, P = .028), disease-specific survival rates did not differ between the 2 groups (97.8% vs 100%, P = .495). A Cox proportional hazards model showed that gastrectomy was not an independent factor associated with overall survival. CONCLUSIONS: Careful follow-up may be an alternative strategy to gastrectomy for a subgroup of patients treated by non-curative ESD with R0 resection.

DOI： 10.1016/j.gie.2016.11.018

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Colorectal laterally spreading tumors (LSTs) are classified into LST-Gs and LST-NGs, according to macroscopic findings. In the present study, we determined the genetic and epigenetic alterations within colorectal LSTs and protruding adenomas. METHODS: A crypt isolation method was used to isolate DNA from tumors and normal glands of 73 macroscopically verified colorectal LSTs (histologically defined adenomas; 38 LST-Gs and 35 LST-NGs) and 36 protruding adenomas. The DNA was processed using polymerase chain reaction (PCR) microsatellite assays, single-strand conformation polymorphism (SSCP) assays, and pyrosequencing to detect chromosomal allelic imbalance (AI), mutations in APC, KRAS, and TP53, and the methylation of MLH1, MGMT, CDKN2A, HPP1, RASSF2A, SFRP1, DKK1, ZFP64, and SALL4 genes. In addition, methylation status was examined using the following set of markers: MIN1, MINT2, MINT31, MLH1, and CDKN2A (with classification of negative/low and high). Microsatellite instability (MSI) was also examined. RESULTS: 5q AI and methylation of the SFRP1 and SALL4 genes were common molecular events in both LST-Gs and LST-NGs. Neither MSI nor mutations in BRAF ware observed in the LSTs. TP53 mutations were rarely found in LSTs. The frequencies of KRAS and APC mutations and the methylation levels of ZFP64, RASSF2A, and HPP1 genes were significantly higher in LST-Gs than in LST-NGs. Protruding adenomas showed alterations common to LST-Gs. Negative/low methylation status was common among the three types of tumors. CONCLUSION: Combined genetic and epigenetic data suggested that the molecular mechanisms of tumorigenesis were different between LST-Gs and LST-NGs.

DOI： 10.1007/s00535-016-1269-y

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although genetic alterations in patients with advanced gastric cancer have been extensively studied, those in patients with intramucosal neoplasia (IMN) are still poorly understood. METHODS: We evaluated genetic differences in 158 IMNs, including 51 low-grade dysplasias, 58 high-grade dysplasias (HGDs), 30 intramucosal cancers (IMCs), and 19 mixed tumors (composed of IMC and HGD within the same tumor), using PCR-based microsatellite analysis [allelic imbalance (AI) and microsatellite instability (MSI)]. We classified the DNA methylation status as a hypermethylated epigenome, a moderately methylated epigenome, or a hypomethylated epigenome. In addition, p53 overexpression, β-catenin nuclear localization, and mucin expression were also examined. RESULTS: From cluster analysis, the IMNs examined were categorized into four subgroups as follows. Tumors in subgroup 1 were characterized by MSI-high status, a hypermethylated epigenome, and loss or reduction of expression of MLH-1. Tumors in subgroup 2 showed a mixed pattern consisting of AI and MSI. In contrast, tumors in subgroup 3, which showed accumulation of multiple AIs, were closely associated with HGD, IMC, or mixed tumor and exhibited nuclear expression of β-catenin. Tumors in subgroup 4, which were generally low-grade dysplasias, exhibited a low frequency of AIs and no MSI. Although the mucin phenotype was not correlated with any subgroup, expression of mucin was associated with some subgroups. Overexpression of p53 was common in all subgroups. CONCLUSION: The approach described herein was useful for studying genetic differences in IMNs. In addition, we suggest that stratification of genetic differences may help to identify genetic molecular profiles in IMNs.

DOI： 10.1007/s10120-016-0616-2

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Circulating tumor DNA (ctDNA) carries information on tumor burden. However, the mutation spectrum is different among tumors. This study was designed to examine the utility of ctDNA for monitoring tumor burden based on an individual mutation profile. METHODOLOGY: DNA was extracted from a total of 176 samples, including pre- and post-operational plasma, primary tumors, and peripheral blood mononuclear cells (PBMC), from 44 individuals with colorectal tumor who underwent curative resection of colorectal tumors, as well as nine healthy individuals. Using a panel of 50 cancer-associated genes, tumor-unique mutations were identified by comparing the single nucleotide variants (SNVs) from tumors and PBMCs with an Ion PGM sequencer. A group of the tumor-unique mutations from individual tumors were designated as individual marker mutations (MMs) to trace tumor burden by ctDNA using droplet digital PCR (ddPCR). From these experiments, three major objectives were assessed: (a) Tumor-unique mutations; (b) mutation spectrum of a tumor; and (c) changes in allele frequency of the MMs in ctDNA after curative resection of the tumor. RESULTS: A total of 128 gene point mutations were identified in 27 colorectal tumors. Twenty-six genes were mutated in at least 1 sample, while 14 genes were found to be mutated in only 1 sample, respectively. An average of 2.7 genes were mutated per tumor. Subsequently, 24 MMs were selected from SNVs for tumor burden monitoring. Among the MMs found by ddPCR with > 0.1% variant allele frequency in plasma DNA, 100% (8 out of 8) exhibited a decrease in post-operation ctDNA, whereas none of the 16 MMs found by ddPCR with < 0.1% variant allele frequency in plasma DNA showed a decrease. CONCLUSIONS: This panel of 50 cancer-associated genes appeared to be sufficient to identify individual, tumor-unique, mutated ctDNA markers in cancer patients. The MMs showed the clinical utility in monitoring curatively-treated colorectal tumor burden if the allele frequency of MMs in plasma DNA is above 0.1%.

DOI： 10.1371/journal.pone.0146275

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIMS: Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) are the main causes of peptic ulcers. The purpose of the present study was to elucidate the time trends of the impact of H. pylori infection and use of NSAIDs and/or antithrombotic agents on peptic ulcer bleeding (PUB) in Japanese patients. METHODS: We retrospectively reviewed 719 patients who had received endoscopic hemostasis for PUB between 2002 and 2013. Subjects were divided into either the first-half group (2002-2007, n = 363) or the second-half group (2008-2013, n = 356). The clinical characteristics of the patients, including the prevalence of H. pylori infection and use of NSAIDs and antithrombotic agents, were compared between the two groups. RESULTS: Compared to the first-half group, patients in the second-half group were characterized by older age (proportion of the patients above 60 years old, 63.9 vs. 76.7%, p = 0.0002), less frequent H. pylori infection (71.6 vs. 57.9%, p < 0.001) and more frequent NSAID intake (39.9 vs. 48.6%, p = 0.02). No significant difference was observed regarding the use of antithrombotic agents between the two groups (18.6 vs. 23.3%, p = 0.13). The prevalence of H. pylori infection and proportion of patients above 60 years old were significantly different between the two groups in a multivariate analysis. CONCLUSION: The main cause of PUB has clearly shifted from H. pylori infection to the use of NSAIDs over the last decade.

DOI： 10.1159/000368810

記述言語：英語   掲載種別：研究論文（学術雑誌）  

開催年月日： 2022年6月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2021年11月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2021年11月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2021年11月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2021年10月

記述言語：日本語  

国名：日本国  

開催年月日： 2021年5月

記述言語：英語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2021年4月 - 2022年5月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2020年11月

記述言語：日本語  

国名：日本国  

開催年月日： 2020年10月

記述言語：日本語  

国名：日本国  

開催年月日： 2020年6月

記述言語：日本語  

国名：日本国  

記述言語：日本語   出版者・発行元：(株)東京医学社  

＜文献概要＞はじめに　腸管Behcet病および単純性潰瘍は,回盲部に単発または多発する潰瘍を特徴とする原因不明の炎症性疾患である。両疾患の消化管病変は同一であると考えられており,口腔内病変,皮膚,および陰部などの腸管外徴候の有無により区別される。本稿では,両疾患にみられる回盲部病変,大腸病変を中心に解説する。

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞●Crohn病の診断において,X線造影検査は重要な役割を果たす.微小病変の描出は難しいものの,粗大病変の全体像や局在の把握において内視鏡検査よりも優れており,癒着や狭窄病変が存在する場合でも評価が可能である.瘻孔の描出や経時的変化の追跡にも有用であり,内視鏡検査を補完する重要な手段である.

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞●特発性虚血性大腸炎,特発性虚血性小腸炎について概説し,自験例を提示した.特発性虚血性腸炎は,主幹動脈の器質的な閉塞を伴わない腸管粘膜の血流障害に起因する病変のうち原因不明なものであり,狭義の虚血性腸病変とされる.特発性虚血性大腸炎の多くは一過性型で保存的加療により軽快するが,重症例では壊死型や狭窄型へと進展し,手術を要する症例もある.特発性虚血性小腸炎の多くは狭窄型であり,手術を回避できる割合は少ないが,近年内視鏡的なバルーン拡張術の有効性も報告されており,検討されるべき治療選択肢と考えられる.

記述言語：日本語   出版者・発行元：(株)医学書院  

記述言語：日本語   出版者・発行元：(株)東京医学社  

記述言語：日本語   出版者・発行元：(株)東京医学社  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞小腸内視鏡機器の進歩・普及に伴い,小腸疾患診断において内視鏡検査は必要不可欠な検査モダリティとなった.低侵襲かつ高い全小腸観察率を特徴とするカプセル内視鏡は,上部・下部内視鏡検査で出血源を認めない原因不明の消化管出血例に対して高い有用性を発揮するが,腸管蠕動により受動的に管腔内を移動する本検査法は小腸病変の精査には不向きであった.しかし,視野角拡大,画像解像度の向上,フレームレート調整機能追加などにより病変性状評価能も改善されてきた.また,本検査法の問題点の一つである画像読影についても,人工知能の応用による見落とし率低下や読影時間短縮の可能性が報告され,有用性・利便性の向上が期待される.

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞小腸疾患の主な検査法として,X線造影検査,内視鏡検査,体外式超音波検査,CTE(CT enterography/enteroclysis),MRE(MR enterography/enteroclysis)が挙げられる.内視鏡,超音波,CTE,MREの機器の進歩と普及,X線検査医の不足により小腸X線造影検査数は減少傾向にある.そこで小腸X線造影検査の有用性と限界について,X線造影像を提示しながら考察した.小腸X線造影検査はびまん性・多発性の病変,大型の病変,狭窄性病変,瘻孔を形成する疾患,管外発育する病変に特に有用である.その特性を理解したうえで,X線造影検査の適応となる疾患を選択することが重要と考える.

記述言語：日本語   出版者・発行元：(株)医学書院  

記述言語：日本語   出版者・発行元：(株)医学書院  

記述言語：日本語   出版者・発行元：(株)医学書院  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   出版者・発行元：消化器内視鏡  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞大腸腫瘍の主な検査法として注腸X線造影検査,内視鏡検査,CTC(CT colonography)が挙げられる.しかし,内視鏡,CTCの機器の進歩と普及,X線検査医の不足により注腸X線造影検査数は減少傾向にある.そこで,注腸X線造影検査の大腸腫瘍診療における位置付けと将来展望について注腸X線造影画像を提示しながら考察した.注腸X線造影検査の絶対的適応は,内視鏡検査で深達度診断に迷う症例と内視鏡挿入困難例と考える.将来展望として,X線造影所見の解析にも人工知能を用いたコンピュータ診断支援システムが搭載され,施行医・読影医の負担が軽減されることが期待される.

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   出版者・発行元：(株)日本臨床社  

記述言語：日本語   出版者・発行元：(株)日本臨床社  

記述言語：日本語   出版者・発行元：(株)日本臨床社  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   出版者・発行元：(株)医学書院  

記述言語：日本語   出版者・発行元：胃と腸  

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記述言語：日本語   出版者・発行元：胃と腸  

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記述言語：日本語   出版者・発行元：胃と腸  

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記述言語：日本語   出版者・発行元：(株)医学書院  

記述言語：日本語   出版者・発行元：(株)医学書院  

記述言語：日本語   出版者・発行元：(株)医学書院  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   出版者・発行元：臨牀と研究  

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記述言語：日本語   出版者・発行元：大道学館出版部  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）