記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/jcb.10295

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1038/sj.bjp.0703141

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1038/sj.bjp.0703737

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1038/sj.bjp.0702821

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Endoscopy  

DOI： 10.1055/a-2371-0911

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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：Endoscopy  

DOI： 10.1055/a-2291-9050

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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：Endoscopy  

DOI： 10.1055/a-2351-3985

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出版者・発行元：南江堂  

DOI： 10.15106/j_naika134_603

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1159/000541121

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Molecular Medicine  

Abstract: 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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1159/000540912

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Gastroenterology  

Background: The cancer risk for each length of Barrett’s esophagus (BE) in Japanese is unknown. This nationwide, multi-institutional study aims to clarify the cancer risk by length of BE in the general Japanese population. Methods: Consecutive subjects who underwent upper endoscopic screening at 17 centers between 2013 and 2017 and had at least one follow-up endoscopy by December 2022 were included. The presence/absence of BE and, if present, its length were retrospectively assessed using the retrieved endoscopic images recorded at baseline. Information on the subsequent occurrence of esophageal adenocarcinoma and other upper gastrointestinal cancers was also collected. Cancer incidence was calculated and expressed as %/year. Results: A total of 33,478 subjects were enrolled, and 17,884 (53.4%), 10,641 (31.8%), 4889 (14.6%), and 64 (0.2%) were diagnosed as absent BE, BE < 1 cm, 1–3 cm, and ≥ 3 cm, respectively. During a median follow-up of 80 months, 11 cases of esophageal adenocarcinoma developed. The annual incidence of esophageal adenocarcinoma is 0%/year for absent BE, 0.0032 (0.00066–0.013)%/year for BE < 1 cm, 0.026 (0.011–0.054)%/year for 1–3 cm, and 0.58 (0.042–2.11)%/year for ≥ 3 cm, respectively. Meanwhile, the incidence of esophageal squamous cell carcinoma and gastric cancer were 0.039 (0.031–0.049)%/year and 0.16 (0.14–0.18)%/year, respectively. Conclusions: By enrolling a large number of subjects with long-term follow-up, this study demonstrated that the risk of cancer increased steadily with increasing length of BE in the Japanese population. Therefore, it is important to consider the length of BE when determining the management strategy for BE.

DOI： 10.1007/s00535-024-02139-2

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記述言語：日本語   出版者・発行元：(株)文光堂  

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

DOI： 10.1111/den.14744

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記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

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。

出版者・発行元：南江堂  

DOI： 10.15106/j_naika133_846

CiNii Research

記述言語：日本語   出版者・発行元：(株)南江堂  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J00974&link_issn=&doc_id=20240416090103&doc_link_id=issn%3D0022-1961%26volume%3D133%26issue%3D4%26spage%3D846&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0022-1961%26volume%3D133%26issue%3D4%26spage%3D846&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Gastric Cancer  

BACKGROUND: In gastric solid-type poorly differentiated adenocarcinoma (PDA), the role of microsatellite instability and immune escape mechanism remains unclear. The current study aimed to elucidate the clinical significance of mismatch repair (MMR) status, genome profile, C-X-C motif chemokine receptor 2 (CXCR2) expression, and myeloid-derived suppressor cell (MDSC) infiltration in solid-type PDA. METHODS: In total, 102 primary solid-type PDA cases were retrieved, and classified into 46 deficient-MMR (dMMR) and 56 proficient-MMR (pMMR) cases based on immunohistochemistry (IHC) and polymerase chain reaction-based molecular testing results. The mRNA expression profiles (NanoString nCounter Assay) of stage-matched dMMR (n = 6) and pMMR (n = 6) cases were examined. The CXCR2 expression and MDSC infiltration (CD11b- and CD33-positive cells) were investigated via IHC in all solid-type PDA cases. RESULTS: mRNA analysis revealed several differentially expressed genes and differences in biological behavior between the dMMR (n = 46) and pMMR (n = 56) groups. In the multivariate analysis, the dMMR status was significantly associated with a longer disease-free survival (hazard ratio = 5.152, p = 0.002) and overall survival (OS) (hazard ratio = 5.050, p = 0.005). CXCR2-high expression was significantly correlated with a shorter OS in the dMMR group (p = 0.018). A high infiltration of CD11b- and CD33-positive cells was significantly correlated with a shorter OS in the pMMR group (p = 0.022, 0.016, respectively). CONCLUSIONS: dMMR status can be a useful prognostic predictor, and CXCR2 and MDSCs can be novel therapeutic targets in patients with solid-type PDA.

DOI： 10.1007/s10120-024-01474-w

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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：Journal of Gastroenterology  

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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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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)

記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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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出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000001233

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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 炎症性腸疾患(inflammatory bowel disease:IBD)は,Crohn病(Crohn's disease:CD)と潰瘍性大腸炎(ulcerative colitis:UC)の2疾患からなる原因不明の慢性炎症性腸疾患である。CDは口腔から肛門まで全消化管に非連続性の炎症や潰瘍をきたし,炎症が壁の全層性に及ぶため,しばしば狭窄や瘻孔,穿通などの消化管合併症を伴うことが特徴である。一方,UCは直腸から連続・びまん性に口側へ広がり原則的には大腸のみに炎症や潰瘍をきたすが上部消化管病変を併発することもある。ただ,炎症の首座は基本的に粘膜であるため,CDのように狭窄や瘻孔,穿通が少ないことが特徴である。本稿では,CDとUCの胃病変について,内視鏡所見や頻度,鑑別疾患,治療を中心に概説する。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J02312&link_issn=&doc_id=20240308110013&doc_link_id=10.24479%2Fendo.0000001233&url=https%3A%2F%2Fdoi.org%2F10.24479%2Fendo.0000001233&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

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Trials  

BACKGROUND: Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric neoplasms (EGN). Controlling intraoperative bleeding is crucial for ensuring safe and reliable procedures. ESD using the spray coagulation mode (SCM-ESD) has been developed to control bleeding more effectively than ESD using the conventional forced coagulation mode (FCM-ESD). This study aims to compare the hemostatic efficacies of SCM-ESD and FCM-ESD. METHODS: This multicenter, prospective, parallel, randomized, open-label superiority trial will be conducted in five Japanese institutions. Patients with a preoperative diagnosis of intramucosal EGC will be randomized to undergo either SCM-ESD or FCM-ESD. The primary outcome measure is the completion of ESD with an electrosurgical knife alone, without the use of hemostatic forceps. Secondary outcomes include the number and duration of hemostasis using hemostatic forceps, procedure time, curability, and safety. A total of 130 patients will be enrolled in this study. DISCUSSION: This trial will provide evidence on the hemostatic efficacy of SCM-ESD compared with FCM-ESD in patients with intramucosal EGN, potentially improving the safety and reliability of ESD procedures. TRIAL REGISTRATION: The trial has been registered at the University Hospital Medical Information Network Clinical Trials Registration (UMIN-CTR) as UMIN000040518. The reception number is R000054009.

DOI： 10.1186/s13063-023-07852-6

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/a-2219-8130

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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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：Endoscopy  

DOI： 10.1055/a-2072-5740

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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：Digestive Endoscopy  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Endoscopy  

DOI： 10.1055/a-2072-3383

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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：Endoscopy  

DOI： 10.1055/a-2155-7172

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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：Endoscopy  

DOI： 10.1055/a-2173-8010

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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：Endoscopy  

DOI： 10.1055/a-2199-3398

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記述言語：日本語   出版者・発行元：日本消化器病学会-九州支部  

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出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000001032

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出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000000999

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出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000001034

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出版者・発行元：医歯薬出版(株)  

DOI： 10.32118/j01532.2024052923

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000002753

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：Trials  

BACKGROUND: We have determined that the impaired accommodation of the lower esophageal sphincter (LES) underlies the pathogenesis of esophagogastric junction outflow obstruction (EGJOO). We have also found that acotiamide may treat EGJOO by improving impaired LES accommodation. The effects of acotiamide in patients with EGJOO need to be further confirmed in a prospective study. METHODS: This trial is a multicenter, randomized, double-blind, placebo-controlled study to compare the efficacy and safety of acotiamide (300 mg/day or 600 mg/day) with those of a placebo in the treatment of patients with EGJOO. The primary endpoint will be the proportion of patients who report an improvement in symptom of food sticking in the chest after 4 weeks of treatment period 1. The secondary endpoints will be the proportion of patients with normalized integrated relaxation pressure (IRP), the value of change from baseline in the distal contractile integral, basal LES pressure, EGJOO-quality of life score, Gastrointestinal Symptom Rating Scale, and the correlation between IRP and each symptom score. During the 2-year trial period, 42 patients from five institutions will be enrolled. DISCUSSION: This trial will provide evidence to clarify the efficacy and safety of acotiamide as a treatment for patients with EGJOO. Acotiamide might help improve the quality of life of patients with EGJOO and is expected to prevent the progression of EGJOO to achalasia. TRIAL REGISTRATION: This study was approved by the Institutional Review Board (IRB) of Kyushu University Hospital as well as the local IRBs of the participating sites for clinical trials and registered in the Japan Registry of Clinical Trials (jRCT: 2071210072). The registration date is on October 11, 2021.

DOI： 10.1186/s13063-023-07468-w

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記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Gastroenterology  

BACKGROUND AND AIM: Colonic self-expandable metallic stent (SEMS) placement enables preoperative total colonoscopy (TCS) in patients with obstructive colorectal cancer. Following SEMS placement, it is possible to assess the presence or absence of synchronous proximal colon cancers and perform preoperative endoscopic resection (ER) for neoplastic lesions proximal to the primary lesion. The objective of this study was to determine the usefulness and safety of preoperative TCS and ER after SEMS placement in patients with obstructive colorectal cancer. METHODS: From April 2016 to March 2022, we enrolled 100 patients with obstructive colorectal cancer who underwent SEMS placement, including 86 patients who underwent preoperative TCS after SEMS placement. Complications associated with preoperative TCS and ER after SEMS placement and the characteristics of the neoplastic lesions were assessed. RESULTS: The success rate of SEMS placement as bridge-to-surgery was 98.0%; six patients had associated complications. Preoperative TCS was performed 8 (range: 1-30) days after SEMS placement. Four patients had synchronous advanced cancers. Nine non-advanced synchronous cancers, 116 adenomas, and 18 sessile-serrated lesions were treated by preoperative TCS and ER after SEMS placement. No procedure-related complications, namely stent migration, bleeding, and perforation were observed. Forty-five patients underwent follow-up TCS 1 year after surgery. Only one patient with submucosal invasive cancer required a second surgery. CONCLUSIONS: Preoperative TCS and ER after SEMS placement was performed with no complications. This approach allows preoperative evaluation of the entire colon and the treatment of precancerous lesions. (240 words).

DOI： 10.1186/s12876-023-02888-z

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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

＜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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出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000000731

CiNii Research

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

We report a rare case of gastric cancer presenting with a gastrocolic fistula during ramucirumab and paclitaxel combination therapy that was successfully managed with colonic stenting. A 75-year-old man was admitted to our hospital with the chief complaint of melena. Esophagogastroduodenoscopy revealed a large ulcerated tumor in the lower stomach, judged by laparoscopy as unresectable (sT4bN1M0). After four cycles of first-line chemotherapy with S-1 plus oxaliplatin, the patient showed disease progression, and second-line therapy with ramucirumab and paclitaxel was started. At the end of the third cycle, the patient had gastric antral stenosis, which necessitated the placement of a gastroduodenal stent. When the patient complained of diarrhea 10 days later, esophagogastroduodenoscopy revealed a fistula between the greater curvature of the stomach and the transverse colon. The fistula was covered by double colonic stenting, with a covered metal stent placed within an uncovered metal stent, after which leakage from the stomach to the colon stopped.

DOI： 10.5946/ce.2022.117

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：英語   出版者・発行元：DEN Open  

A 68-year-old man was referred to our hospital for endoscopic treatment of colon polyps detected at a local clinic. Colonoscopy revealed not only classical adenomatous polyps in the transverse and sigmoid colon but also an atypical pedunculated polyp in the terminal ileum with the head of the lesion moving back and forth through the ileocecal valve. Based on the endoscopic findings, the pedunculated polyp was diagnosed as a non-epithelial tumor of the ileum. However, traction-assisted endoscopic submucosal dissection was performed because of the high risk of intestinal intussusception or obstruction. Histopathological analysis of the resected specimen revealed that the pedunculated polyp was a non-inverted ileal pseudodiverticulum filled with feces. We report the first case of a feces-filled non-inverted pseudodiverticulum presenting as a pedunculated polyp successfully treated by traction-assisted endoscopic submucosal dissection.

DOI： 10.1002/deo2.139

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

症例は68歳男性で、近医で指摘された大腸ポリープの内視鏡的治療目的で紹介受診した。大腸内視鏡検査で、典型的な腺腫様ポリープを横行結腸およびS状結腸に認めたが、それに加えて、先端が回盲弁を行き来する終末回腸に非典型的な有茎性ポリープが認められた。内視鏡的所見から、この有茎性ポリープは回腸由来の非上皮性腫瘍と診断された。重積および閉塞のリスクがあると考えられたため、牽引補助下内視鏡的粘膜下層剥離術(ESD)を施行した。組織病理学的には、有茎性ポリープは非反転回腸偽憩室で、内部に便が充満していた。ポリープ先端に認められた陥凹部は憩室の開口部で、異所性胃粘膜、異所性膵組織は認められず、メッケル憩室も除外された。処置後の経過に特に問題はなく、処置後2日目に退院した。

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般財団法人 日本消化器病学会  

<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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIMS: The etiology of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. Recent studies have reported conflicting associations between duodenal tumor development and Helicobacter pylori (H. pylori) infection or endoscopic gastric mucosal atrophy. As such, the present study aimed to clarify the relationship between SNADETs and H. pylori infection and/or endoscopic gastric mucosal atrophy. METHODS: This retrospective case-control study reviewed data from 177 consecutive patients with SNADETs who underwent endoscopic or surgical resection at seven institutions in Japan over a three-year period. The prevalence of endoscopic gastric mucosal atrophy and the status of H. pylori infection were compared in 531 sex- and age-matched controls selected from screening endoscopies at two of the seven participating institutions. RESULTS: For H. pylori infection, 85 of 177 (48.0%) patients exhibited SNADETs and 112 of 531 (21.1%) control patients were non-infected (p<0.001). Non-atrophic mucosa (C0 to C1) was observed in 96 of 177 (54.2%) patients with SNADETs and 112 of 531 (21.1%) control patients (p<0.001). Conditional logistic regression analysis revealed that non-atrophic gastric mucosa was an independent risk factor for SNADETs (odds ratio, 5.10; 95% confidence interval, 2.44-8.40; p<0.001). CONCLUSIONS: Non-atrophic gastric mucosa, regardless of H. pylori infection status, was a factor independently associated with SNADETs.

DOI： 10.5946/ce.2022.059

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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：Endoscopy  

DOI： 10.1055/a-1982-3875

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記述言語：英語   出版者・発行元：Clinical Gastroenterology and Hepatology  

DOI： 10.1016/j.cgh.2022.12.004

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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：Frontiers in Neuroscience  

We aimed to establish a novel murine model of autoimmune autonomic ganglionopathy (AAG), which represents autoimmune dysautonomia, associated with MHC class II to understand its pathomechanism and the pathogenicity of nicotinic acetylcholine receptor (nAChR) antibodies. The amino acid sequence of the mouse nAChRα3 protein was analyzed using an epitope prediction tool to predict the possible MHC class II binding mouse nAChRα3 peptides. We focused on two nAChRα3 peptides in the extracellular region, and experimental AAG (EAAG) was induced by immunization of C57BL/6 mice with these two different peptides. EAAG mice were examined both physiologically and histologically. Mice with EAAG generated nAChRα3 antibodies and exhibited autonomic dysfunction, including reduced heart rate, excessive fluctuations in systolic blood pressure, and intestinal transit slowing. Additionally, we observed skin lesions, such as alopecia and skin ulcers, in immunized mice. Neuronal cell density in the sympathetic cervical ganglia in immunized mice was significantly lower than that in control mice at the light microscopic level. We interpreted that active immunization of mice with nAChRα3 peptides causes autonomic dysfunction similar to human AAG induced by an antibody-mediated mechanism. We suggested a mechanism by which different HLA class II molecules might preferentially affect the nAChR-specific immune response, thus controlling diversification of the autoantibody response. Our novel murine model mimics AAG in humans and provides a useful tool to investigate its pathomechanism.

DOI： 10.3389/fnins.2022.1006923

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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：Gastrointestinal Endoscopy  

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 &amp;lt;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&amp;lt;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.

DOI： 10.1016/j.gie.2022.11.022

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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：Clinical Gastroenterology and Hepatology  

BACKGROUND &amp; AIMS: Hybrid endoscopic submucosal dissection (H-ESD), which incorporates ESD with endoscopic mucosal resection, has been developed to make ESD technically easier. This study aimed to determine if H-ESD is superior to conventional ESD (C-ESD) for small early gastric neoplasms (EGN). METHODS: We conducted a multi-center, prospective, open-label, randomized controlled trial to compare the treatment outcomes of H-ESD and C-ESD (Hybrid-G Trial). The patients with differentiated-type intramucosal EGN ≤ 20 mm in diameter and without ulceration were randomly assigned (1:1) to groups that underwent H-ESD or C-ESD. A single multi-functional snare, SOUTEN (ST1850-20, Kaneka, Medix, Tokyo, Japan), was used for H-ESD. The primary outcome was procedure time. Secondary outcomes included mucosal incision time, time and speed of submucosal dissection, curability, and endoscopic procedural adverse events. RESULTS: A total of 39 and 40 patients underwent H-ESD and C-ESD, respectively. The procedure time of H-ESD was significantly shorter than that of C-ESD (33.16 min vs. 62.46 min, H-ESD/C-ESD ratio: 0.53, 95&amp;#37; confidence interval 0.41-0.69, P<0.0001). There was no significant difference in mucosal incision time between the two groups; the time and speed of submucosal dissection of H-ESD were significantly shorter than those of C-ESD. No difference was observed between the two groups in other outcomes. CONCLUSIONS: H-ESD has significantly shorter procedure time than C-ESD, with high and comparable curability and safety for both H-ESD and C-ESD. H-ESD can be a good option for the endoscopic treatment of small EGNs.

DOI： 10.1016/j.cgh.2022.10.030

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記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

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。

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

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.

DOI： 10.1038/s41598-022-20863-8

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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：Gastrointestinal Endoscopy  

BACKGROUND & AIMS: Peroral endoscopic myotomy (POEM) is conducted for patients with esophageal motility disorders based on high-resolution manometry (HRM) findings. However, the impact of POEM on HRM findings and the associations between post-POEM HRM and outcomes have not been clarified. METHODS: In a multicenter, observational cohort study, patients with achalasia treated by POEM received follow-up HRM. Associations between patient characteristics, POEM procedures, and post-POEM HRM findings, including integrated relaxation pressure (IRP) and distal contractile integral (DCI), were investigated. Furthermore, the outcomes of the POEM procedure were compared with the post-POEM HRM findings. RESULTS: Of 2,171 patients, 151 (7.0%) showed residual high post-POEM IRP (≥26 mmHg, Starlet). In a multivariate analysis, high pre-POEM IRPs (odds ratio [OR]=24.3) and gastric myotomy >2 cm (OR=0.22) were found to be positive and negative predictive factors of high post-POEM IRPs, respectively. Peristalsis recovery (DCI ≥500 mmHg-cm-sec, at least one swallow, Starlet) was visible in 121 (19.6%) of 618 patients, and they were type II-III achalasia. High pre-POEM IRP (OR=2.65) and DCI ≥500 (OR=2.98) predicted peristalsis recovery, while esophageal dilation (OR=0.42) predicted a risk of no recovery. Extended myotomy did not reveal a significant impact on peristalsis recovery. High or low post-POEM IRP and DCI did not increase the incidence of clinical failure, reflux esophagitis, or symptomatic gastroesophageal reflux disease. CONCLUSIONS: Extended gastric myotomy decreased IRP values, while peristalsis recovery depended on the characteristics of achalasia. A residual high post-POEM IRP does not necessarily mean clinical failure. Routine HRM follow-up is not recommended after POEM.

DOI： 10.1016/j.gie.2022.10.039

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記述言語：英語   出版者・発行元：Endoscopy  

DOI： 10.1055/a-1662-4965

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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：Endoscopy  

DOI： 10.1055/a-1934-9752

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000002301

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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：Endoscopy  

DOI： 10.1055/a-1889-4838

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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：Journal of Gastroenterology  

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.

DOI： 10.1007/s00535-022-01913-4

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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：Digestive Diseases and Sciences  

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

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

＜文献概要＞はじめに 胃食道逆流症(gastroesophageal reflux disease;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.GERDは,粘膜傷害を伴う逆流性食道炎と粘膜傷害を認めない非びらん性胃食道逆流症(non-erosive reflux disease;NERD)に分類される.GERD診療の難しさは,症状から診断されるNERD(広義のNERD)の約半数にGERD以外の病態が紛れ込んでしまうことにある.最近,食道機能を可視化する食道生理機能検査の発展と共にGERD診療が飛躍的に進歩した.本稿ではGERD診断およびその鑑別診断に重要な検査法とその診断基準について概説する.

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出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000000262

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：Digestive Endoscopy  

Endoscopic submucosal dissection (ESD) is globally performed to treat early epithelial tumors of the gastrointestinal tract, but delayed perforation is a problematic procedure-related complication. To address this problem, closure of ESD-induced mucosal defects with a detachable snare has been reported. However, one problem is that this method usually requires some degree of skill and replacing a single-channel scope with a two-channel scope. We developed the clip stopper closure (CSC) method using a detachable snare in combination with the ZEOCLIP, which can be easily performed with a single-channel scope, for ESD-induced mucosal defects. Six consecutive cases were treated with this closure method for colonic ESD-induced mucosal defects. The median closure time was 12.5 (10-24) min, and the success rate of this procedure was 100%. Our CSC method was able to be performed in any part of the colon. In conclusion, the CSC method using a detachable snare in combination with the ZEOCLIP is a simple but promising closure technique for ESD-induced mucosal defects.

DOI： 10.1111/den.14417

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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：Surgical Endoscopy  

BACKGROUND: Mucosal incision-assisted biopsy (MIAB) is a valuable alternative to endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNAB) for sampling gastric subepithelial lesions (SELs). This study aimed to evaluate the potential risk of dissemination and impact on postoperative prognosis associated with MIAB, which has not yet been investigated. METHODS: Study 1: A prospective observational study was conducted to examine the presence or absence and growth rate of tumor cells in gastric juice before and after the procedure in patients with SELs who underwent MIAB (n = 25) or EUS-FNAB (n = 22) between September 2018 and August 2021. Study 2: A retrospective study was conducted to examine the impact of MIAB on postoperative prognosis in 107 patients with gastrointestinal stromal tumors diagnosed using MIAB (n = 39) or EUS-FNAB (n = 68) who underwent surgery between January 2001 and July 2020. RESULTS: In study 1, although no tumor cells were observed in gastric juice in MIAB before the procedure, they were observed in 64% of patients after obtaining samples (P < 0.001). In contrast, no tumor cells were observed in the gastric juice in EUS-FNAB before and after the procedure. In study 2, there was no significant difference in 5-year disease-free survival between MIAB (100%) and EUS-FNAB (97.1%) (P = 0.27). CONCLUSION: MIAB is safe, with little impact on postoperative prognosis, although the procedure releases some tumor cells after damaging the SEL's pseudocapsule.

DOI： 10.1007/s00464-022-09419-z

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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：Endoscopy  

DOI： 10.1055/a-1841-5907

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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：Digestive Endoscopy  

Although a large-caliber endoscope (LCE) is indispensable for through-the-scope placement of a self-expandable metallic stent (SEMS) in patients with malignant colonic obstruction (MCO), inaccessibility of the target obstructing lesion (TOL) by the endoscope is a significant cause of unsuccessful procedures. We herein present a novel salvage procedure when the TOL is not directly accessible by an LCE in conditions such as coexisting peritoneal carcinomatosis involving the colon. The salvage procedure, termed over-the-catheter endoscope replacement (OCER), starts with an ultraslim endoscope suitable for deep insertion beyond a tortuous colon for traversing a guidewire through the TOL. The ultraslim endoscope is then withdrawn and replaced by an LCE through the following steps. An endoscopic retrograde cholangiopancreatography catheter is preloaded in the LCE, the catheter alone is passed over the guidewire already traversed through the TOL, and the LCE is navigated over the catheter as far as possible toward the TOL to deliver the SEMS delivery system in a standard through-the-scope manner or further in an over-the-wire manner even if LCE insertion is incomplete. Among the 165 patients with MCO who underwent stenting during our study period, OCER led to successful procedures in all 9 patients whose TOLs were initially inaccessible because of colon-involving peritoneal carcinomatosis. By utilizing the functions of distinctive endoscopes in a unique and complementary way, OCER can be a practical salvage option for challenging cases of MCO that are highly prone to unsuccessful palliation by conventional SEMS placement.

DOI： 10.1111/den.14385

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403202920

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：Digestive Diseases  

BACKGROUND: Neuroendocrine neoplasms of the ampulla of Vater (ampullary NEN) have features of both gastrointestinal and pancreato-biliary (PB) NEN. However, the limited number of studies examining ampullary NEN makes it difficult to clarify their unique characteristics. This study aimed to elucidate the clinical characteristics of ampullary NEN. METHODS: We enrolled 162 patients with PB-NEN diagnosed at Kyushu University Hospital between 2011 and 2020. Clinical features, pathological diagnoses, treatments, and prognoses were retrospectively analyzed. We also compared ampullary NEN with pancreatic NEN (PanNEN). RESULTS: We analyzed 10 ampullary NEN cases and 149 PanNEN cases. The ampullary NEN cases consisted of four cases of NET G1 (neuroendocrine tumor Grade 1), one NET G2 (Grade 2), and five NECs (neuroendocrine carcinoma). The incidences of NEC and cholangitis were significantly higher in ampullary NEN than in PanNEN. All ampullary NETs had a submucosal tumor-like appearance, as identified by endoscopic ultrasound-guided fine needle aspiration. We treated small NET G1 (<10 mm) with endoscopic papillectomy and large NET G1 with pancreaticoduodenectomy. There were no cases of recurrence after resection. All ampullary NECs presented with the characteristic endoscopic finding of a ''crater sign" similar to deep-mining ulcers seen in gastric malignant lymphoma. Four cases underwent surgical resection, and one case was unresectable. Two patients who underwent multidisciplinary treatment were maintained without recurrence for over 2 years. CONCLUSIONS: Endoscopic findings showed identifiable distinctions between ampullary NETs and NECs.

DOI： 10.1159/000525013

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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,女性.近医で十二指腸病変を指摘されたため,当科に紹介され受診となった.十二指腸内視鏡検査で十二指腸球部後壁に径20mm大の二段隆起を呈する粘膜下腫瘍様隆起性病変を認め,上部に広く浅い潰瘍を形成していた.潰瘍からの生検で神経内分泌腫瘍(NET)の診断となり,十二指腸部分切除術・リンパ節郭清が施行された.切除標本病理学的所見はNET G2,pT3(SS),ly0,v1であり,リンパ節転移を認めた.本症例は上皮が欠損し,さらに表層に腫瘍自体が露出し,かつ二段隆起を呈した症例であった.

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

Endoscopic submucosal dissection (ESD) is effective for the treatment of colorectal neoplasms. We have developed a self-completion ESD (S-ESD) using Endosaber without requiring additional instruments or assistance. This prospective cohort study was conducted to investigate the feasibility of S-ESD for colorectal neoplasms. Patients with colorectal neoplasms measuring 20-40 mm in size were enrolled. A single operator, without assistance, performed ESD using only the Endosaber. The primary outcome was the success rate of S-ESD. Secondary outcomes included procedure time, the rates of en bloc, complete, and curative resection, and complication rates, including the incidence of perforation and delayed bleeding. In total, 15 patients with 15 lesions were enrolled. The median size of the resected lesions was 28 mm (interquartile range 25-29 mm). S-ESD success rate of 100&#37; was achieved. The median procedure time was 44 min (29.5-53.5 min). We observed en bloc, complete, and curative resection rates of 100&#37;, 93.3&#37;, and 86.7&#37;, respectively, and a complication rate of 6.7&#37; (perforation: 0&#37;, delayed bleeding: 6.7&#37;). S-ESD for colorectal neoplasms was successfully performed with favorable treatment outcomes and low complication rates. S-ESD reduces the number of devices and extent of assistance, making S-ESD a simple and cost-effective procedure.

DOI： 10.1038/s41598-022-09792-8

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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：DEN Open  

Objective: To compare treatment outcomes between injection endoscopic submucosal dissection using ProKnife (P-ESD) and conventional ESD (C-ESD) for gastric lesions. Methods: In this randomized controlled trial, we compared treatment outcomes of P-ESD and C-ESD for simulated gastric lesions ≥3 cm in resected porcine stomachs. Predictive factors associated with ESD difficulties were investigated using logistic regression analysis. Results: Seventy lesions were screened; however, two lesions were excluded. A total of 12 endoscopists performed 68 ESDs: 34 P-ESDs and 34 C-ESDs. The ESD procedure time of P-ESD (36.3 [28.4-46.8] min) was significantly shorter than that of C-ESD (46 [36.4-64.6] min; p = 0.0014). The technical success rates did not differ between the P-ESD and C-ESD groups (en bloc resection rate, 100&#37; in both groups; complete resection rate, 94.1&#37; and 85.3&#37;, respectively; p = 0.23). The number of injections during P-ESD (7.5 [6-10] times) was significantly higher than during C-ESD (4 [3-5] times; p < 0.001), but the total volume of injected solution during P-ESD (20 [16-26.3] ml) was significantly smaller than during C-ESD (27.5 [20-31.5] ml; p = 0.0019). In multivariate analysis, less ESD experience (odds ratio [OR], 3.9) and selection of C-ESD as the ESD method (OR, 3.8) were independent predictive factors associated with ESD difficulties. Conclusions: Compared with C-ESD, P-ESD had a shorter procedure time but also allowed for notable technical success and safety.

DOI： 10.1002/deo2.91

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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：Endoscopy  

DOI： 10.1055/a-1809-4967

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記述言語：英語   出版者・発行元：DEN Open  

Congenital duodenal diaphragm (CDD) is a rare disease that is usually diagnosed in the neonatal period; however, it is sometimes diagnosed later in the adult period. A 39-year-old woman was referred to our hospital due to tarry stool and anemia. Emergent esophagogastroduodenoscopy (EGD) revealed an obstructing membranous structure with a small orifice in the second portion of the duodenum, together with dilatation of the bulbar part. The membranous structure was accompanied by a Dieulafoy-like vessel on the backside, which was considered to have caused tarry stool and anemia. The Dieulafoy-like vessel was successfully treated by endoscopic hemostasis. Based on the computed tomographic gastrography and barium duodenography findings, it was diagnosed as CDD. Later, endoscopic resection of the diaphragm was conducted by an endoscopic submucosal dissection (ESD)-based procedure, with the use of an electrosurgical grasping-type scissor forceps (ClutchCutter [CC]). There were no procedure-related complications. The definite diagnosis of CDD was made based on the observation of typical structures in a pathological examination. This is the first case report of adult CDD that was successfully treated by endoscopic resection using ESD-based techniques with a CC.

DOI： 10.1002/deo2.93

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記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

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。

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

Ex vivoブタモデルの胃病変70ヵ所に対して、ProKnifeを用いた内視鏡的粘膜下層剥離術(P-ESD)または従来法の内視鏡的粘膜下層剥離術(C-ESD)を無作為に振り分け、12名の内視鏡医が施行した。各群1病変を粘膜肥厚のため除外したことにより、検討対象は各群34病変となった。処置時間はP-ESD群が36.3(28.4-46.8)分、C-ESD群が46(36.4-64.6)分で、有意にP-ESD群が短かった(P=0.0014)。技術的成功率には差は認められなかった(一括切除率は両群とも100%、完全切除率はP-ESD群94.1%、C-ESD群85.3%、P=0.23)。P-ESD処置中の注入回数は7.5(6-10)回で、C-ESD群の4(3-5)回よりも有意に多かった(P<0.001)が、注入薬液総量はP-ESD群が20(16-26.3)ml、C-ESD群が27.5(20-31.5)mlで、P-ESD群が有意に少なかった(P=0.0019)。多変量解析の結果、ESD未熟練(オッズ比(OR)3.9)、C-ESD法(OR3.8)がESD困難性の独立した予測因子であった。

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

症例は39歳女性で、タール便および貧血のため紹介受診した。緊急上部消化管内視鏡検査で十二指腸下行脚に小孔を伴う膜様狭窄を認め、十二指腸球部の拡張を伴っていた。膜様構造の裏面にデュラフォイ様血管が認められ、タール便および貧血の原因と考えられた。デュラフォイ様血管に対しては、内視鏡的止血を施行した。CT胃造影検査およびバリウム十二指腸造影検査より、先天性十二指腸膜様狭窄症と診断した。内視鏡的粘膜下層剥離術(ESD)に準じた手法で、通電式把持型剪刀鉗子(ClutchCutter)を用いて十二指腸隔膜を切除した。処置関連合併症は認められなかった。切除標本の病理学的検査により、先天性十二指腸膜様狭窄症と確定診断された。

記述言語：英語   出版者・発行元：(一社)日本内科学会  

症例は74歳女性で、関節リウマチ(RA)と診断され、標準治療で改善しなかったため、紹介来院した。同年の毎年行う大腸内視鏡検査では、潰瘍や憩室は認めなかった。翌年、トシリズマブ治療を開始したところ、症状が改善した。トシリズマブ治療を開始後6ヵ月時に血便と腹痛を訴えた。緊急大腸内視鏡検査を行い、盲腸から横行結腸に広がる不整な多発性潰瘍が判明した。憩室の徴候は認めなかった。生検の病理学的所見では、陰窩上皮細胞に複数のアポトーシスが認められた。トシリズマブ以外の服用薬は、プレドニゾロン、メトトレキサート、ロキソプロフェン、フォリアミン、ランソプラゾール、レバミピド、レボチロキシン、ロスバスタチン、エゼチミブ、フルコナゾールであった。腸管粘膜損傷は、トシリズマブの合併症として発現したことが疑われた。トシリズマブを中止したところ、血便と腹痛が改善した。トシリズマブ中止後1ヵ月時の追跡大腸内視鏡検査において、潰瘍はすべて完全に治癒していた。トシリズマブの代わりにトファシチニブ投与を行ったが、RA再発は認められなかった。

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Trials  

BACKGROUND: Endoscopic submucosal dissection (ESD) is widely accepted as a local treatment for gastrointestinal tract tumors. As a simplified endoscopic procedure, hybrid ESD (H-ESD) has been performed for colorectal neoplasms in recent times. However, whether H-ESD is superior to conventional ESD (C-ESD) for patients with early gastric neoplasms (EGN) remains unclear. In this trial, we will compare the treatment outcomes of H-ESD and C-ESD. We hypothesize that the procedure time for H-ESD is shorter than that for C-ESD. METHODS: This is an investigator-initiated, multi-center, prospective, randomized, open-label, parallel-group trial to be conducted beginning in August 2020 at nine institutions in Japan. We will determine if H-ESD is superior to C-ESD in terms of procedure time in patients with EGN diagnosed as macroscopically intramucosal (T1a) differentiated carcinoma ≤ 20 mm in diameter without ulcerative findings according to current Japanese gastric cancer treatment guidelines. A total of 82 patients will be recruited and randomly assigned to either the C-ESD or the H-ESD group. The primary outcome is ESD procedure time. Secondary outcomes include mucosal incision, time and speed of submucosal dissection, en bloc resection, complete resection, curability, adverse events related to the ESD procedure, extent of dissection before snaring, volume of injection solution, number and time of hemostasis, thickness of the submucosal layer in the resected specimen, and handover to another operator. The stated sample size was determined based on the primary outcome. According to a previous report comparing the procedure times of C-ESD and H-ESD, we hypothesized that H-ESD would provide a 0.2 reduction in logarithmically concerted procedure time (-37&#37;). We estimated that a total of 82 participants were needed to reach a power of 80&#37; for a t-test with a significance level of 0.05 and considering a 10&#37; dropout. DISCUSSION: This trial will provide high-quality data on the benefits and risks of H-ESD for EGN patients. The results of this study could lead to improved outcomes in patients with EGN undergoing ESD. The results will be presented at national and international meetings and published in peer-reviewed journals. TRIAL REGISTRATION: UMIN-CTR UMIN000041244 . Registered on July 29, 2020.

DOI： 10.1186/s13063-022-06099-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In Japan, with the increasing prevalence of gastroesophageal reflux disease (GERD) and growing public interest, the Japanese Society of Gastroenterology issued Evidence-based Clinical Practice Guidelines for GERD (1st edition) in 2009 and a revised 2nd edition in 2015. A number of studies on GERD were subsequently conducted in Japan and abroad, and vonoprazan, a potassium-competitive acid blocker (P-CAB), became available for the first time in Japan in February 2015. The revised 3rd edition (Japanese edition), which incorporates new findings and information, was published in April 2021. These guidelines are summarized herein, particularly sections related to the treatment of GERD. The important clinical issues addressed in the present revision are (i) the introduction of treatment algorithms that classify GERD into reflux esophagitis and non-erosive reflux disease, (ii) the clarification of treatment algorithms based on to the severity of reflux esophagitis, and (iii) the positioning of vonoprazan in the treatment for GERD. The present guidelines propose vonoprazan as the initial/maintenance treatment for severe reflux esophagitis. They also recommend vonoprazan or PPI as an initial treatment for mild reflux esophagitis and recommended PPI and proposed vonoprazan as maintenance treatment. These updated guidelines offer the best clinical strategies for GERD patients in Japan and hope that they will be of global use for the diagnosis and treatment for GERD.

DOI： 10.1007/s00535-022-01861-z

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記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

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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：Virchows Archiv  

Solid-type poorly differentiated adenocarcinoma (PDA) of the stomach is frequently associated with microsatellite instability (MSI) and aberrations of the SWI/SNF chromatin remodeling complex. Previous studies showed that aberrant ARID1A and SMARCA4 expression induces mesenchymal transition. We analyzed 51 primary-site cases and 209 metastatic lymph nodes among solid-type PDA for the expression of SWI/SNF complex subunits (ARID1A, SMARCA4, SMARCB1, SMARCC2) and epithelial-mesenchymal transition (EMT) markers (E-cadherin, β-catenin, Snail). We also analyzed 40 cases of non-solid-type PDA as a stage-matched control group. Aberrant expression of ARID1A (39&#37;) and SMARCA4 (49&#37;) was more common in solid-type PDA than in non-solid-type PDA (ARID1A, P = 0.0049; SMARCA4, P < 0.0001). The group of solid-type PDA with aberrant ARID1A showed significantly longer overall and progression-free survival than the corresponding ARID1A-retained group (P = 0.0405 and P = 0.0296, respectively). Aberrant expression of EMT factors inducing mesenchymal transition in the groups with solid-type PDA at the primary site or metastatic lymph nodes with aberrant ARID1A was less common than in the corresponding groups with retained ARID1A (E-cadherin, primary site P = 0.0341, lymph node P < 0.0001; β-catenin, primary site P = 0.0293, lymph node P = 0.0010; Snail, primary site P = 0.0169, lymph node P = 0.0828). Furthermore, N3 of the TNM classification was more frequently observed in the group with solid-type PDA with retained ARID1A than in the corresponding ARID1A-aberrant group (P = 0.0288). Mesenchymal transition was not induced in the ARID1A-aberrant group, in which patients had favorable prognosis, and preserved epithelial characteristics in EMT may play an important role in low tumor aggressiveness of solid-type PDA.

DOI： 10.1007/s00428-021-03261-9

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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：Therapeutic Advances in Gastroenterology  

Objectives: The colonic self-expandable metallic stent (C-SEMS) with a 9-French (Fr) delivery system allows for a small-caliber endoscope (SCE) to be used to treat malignant colonic obstruction. Despite the lack of evidence, the SCE has become popular because it is considered easier to insert than the large-caliber endoscope (LCE). We aimed to determine whether the SCE is more suitable than the LCE for C-SEMS placement. Methods: Between July 2018 and November 2019, 50 consecutive patients who were scheduled to undergo C-SEMS for colon obstruction were recruited in this study. Patients were randomized to the SCE or LCE group. The SCE and LCE were used with 9-Fr and 10-Fr delivery systems, respectively. The primary outcome was the total procedure time. Secondary outcomes were the technical success rate, complication rate, clinical success rate, insertion time, guidewire-passage time, stent-deployment time, and colonic obstruction-scoring-system score. Results: Forty-five patients (SCE group, n = 22; LCE group, n = 23) were analyzed. The procedure time in the LCE group (median, 20.5 min) was significantly (p = 0.024) shorter than that in the SCE group (median, 25.1 min). The insertion time in the LCE group (median, 2.0 min) was significantly (p = 0.0049) shorter than that in the SCE group (median, 6.0 min). A sub-analysis of the procedure difficulties showed that the insertion time in the LCE group (median, 5.0 min) was significantly shorter than that in the SCE group (median, 8.5 min). Conclusion: Both LCE and SCE can be used for C-SEMS; however, LCE is more suitable than SCE as it achieved a faster and equally efficacious C-SEMS placement as that of SCE. Clinical trial registration number: University Hospital Medical Information Network Clinical Trials Registry (UMIN 32748).

DOI： 10.1177/17562848211065331

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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：Esophagus  

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 (&amp;lt; 15 mmHg) in 13 of 25 patients with EGJOO (52&amp;amp;#37;), and the IRP was decreased in 20 of 25 patients with EGJOO (80&amp;amp;#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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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  

Intestinal mucosal injury that develops as a complication of tocilizumab (TCZ) is usually associated with diverticulosis. We herein report a rare case of TCZ-induced intestinal mucosal injury in the absence of diverticulosis. A 74-year-old woman suffering from rheumatoid arthritis started taking TCZ. Six months later, she complained of hematochezia and abdominal pain. Colonoscopy revealed multiple ulcers spreading from the cecum to the transverse colon but no diverticulosis. These lesions were cured at three months after the discontinuation of TCZ. We should consider TCZ as a risk factor for intestinal mucosal injury, even if patients have no history of intestinal disease associated with diverticulosis.

DOI： 10.2169/internalmedicine.8031-21

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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：Endoscopic Ultrasound  

DOI： 10.4103/EUS-D-21-00043

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   出版者・発行元：Digestive Diseases and Sciences  

DOI： 10.1007/s10620-021-07235-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction: Endoscopic submucosal dissection (ESD) is a less invasive local treatment for early gastric cancer (EGC).Areas covered: Japanese guidelines have recently expanded the endoscopic treatment indications for EGC. ESD is sometimes performed for lesions with a relative indication that has not previously been considered for ESD. ESD procedures are technically difficult, especially for larger and more invasive lesions. Complete resection and accurate histological assessment of EGC lesions are essential to evaluate endoscopic curability. Various endoscopic instruments, including three types of endoscopic knives and specific hemostatic forceps, have been developed, and endoscopic techniques, including the traction method, have been modified to simplify the procedure.Expert opinion: An insulated-tip knife with large tissue contact allows us to perform faster incisions, while a needle-type knife with minimal tissue contact allows us to perform precise incisions. Furthermore, a scissor-type knife with grasping tissues allows us to perform more secure incision. The traction method enables the operator to proceed with submucosal dissection procedures. In cases with small lesions, snaring can be used, as well as knife dissection. Understanding the features of each endoscopic instrument and technique is essential because appropriate selection and usage contribute to successful and safe ESD procedures.

DOI： 10.1080/17474124.2021.1924056

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/den.13978

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Neurogastroenterology and Motility  

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: Thirty-two percent of 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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Hybrid endoscopic submucosal dissection (ESD) that comprises mucosal incision and partial submucosal dissection followed by snaring in a planned manner, has been developed for endoscopic resection of gastrointestinal neoplasms to overcome the technical barrier of ESD. Although the superiority of hybrid ESD with SOUTEN, a single multifunctional device, over conventional ESD has been indicated, the actual effect of snaring itself remains unclear since SOUTEN could be applied to hybrid ESD group, but not to the conventional ESD group, due to ethical issue in clinical practice. AIM: To determine whether and how hybrid ESD was superior to conventional ESD in the endoscopic treatment of gastric lesions in an ex vivo porcine model basic study. METHODS: Sixteen endoscopists participated in this basic study in August 2020 at Kyushu University, performing 32 procedures each for hybrid ESD and conventional ESD. Mock lesions (10-15 mm, diameter) were created in the porcine stomach. The primary outcome was total procedure time and secondary outcomes were en bloc or complete resection, perforation, procedure time/speed for both, mucosal incision, and submucosal dissection. Factors associated with difficulty in ESD including longer procedure time, incomplete resection, and perforation, were also investigated. Categorical and continuous data were analyzed using the chi-square test or Fisher's exact test and the Mann-Whitney U test, respectively. RESULTS: The median total procedure time of hybrid ESD was significantly shorter than that of conventional ESD (median: 8.3 min vs 16.2 min, P < 0.001). Time, speed, and the amount of hyaluronic acid during submucosal dissection were more favorable in hybrid ESD than conventional ESD (time, 5.2 min vs 10.4 min, P < 0.001; speed, 43.7 mm2/min vs 23.8 mm2/min, P < 0.00; injection volume, 1.5 mL vs 3.0 mL, P < 0.001), although no significant differences in those factors were observed between both groups during mucosal incision. There was also no significant difference between both groups in the en bloc/complete resection rate and perforation rate (complete resection, 93.8&#37; vs 87.5&#37;, P = 0.67; perforation, 0&#37; vs 3.1&#37;, P = 1). Selection of conventional ESD as the treatment method was significantly associated with difficulties during ESD (odds ratio = 10.2; highest among factors). CONCLUSION: Hybrid ESD with SOUTEN improves the treatment outcomes of gastric lesions. It also has the potential to reduce medical costs since SOUTEN is a single multifunctional device that is inexpensive.

DOI： 10.4240/wjgs.v13.i6.563

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/den.13954

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10753-020-01358-y

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Endoscopy  

DOI： 10.1055/a-1422-2902

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10753-020-01358-y

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.4240/wjgs.v13.i2.116

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12876-021-01656-1

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000502771

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1155/2021/6691705

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.4251/wjgo.v12.i8.918

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Autoimmune gastrointestinal dysmotility (AGID), an idiopathic or paraneoplastic phenomenon, is a clinical form of limited autoimmune dysautonomia. The symptoms of AGID and gastrointestinal manifestations in patients with autoimmune rheumatic diseases are overlapping. Antineuronal autoantibodies are often detected in patients with AGID. Autoantibodies play a key role in GI dysmotility; however, whether they cause neuronal destruction is unknown. Hence, the connection between the presence of these autoantibodies and the specific interference in synaptic transmission in the plexus ganglia of the enteric nervous system has to be determined. The treatment options for AGID are not well-defined. However, theoretically, immunomodulatory therapies have been shown to be effective and are therefore used as the first line of treatment. Nonetheless, diverse combined immunomodulatory therapies should be considered for intractable cases of AGID. We recommend comprehensive autoimmune evaluation and cancer screening for clinical diagnosis of AGID. Univocal diagnostic criteria, treatment protocols, and outcome definitions for AGID are required for prompt diagnosis and treatment and appropriate management of immunotherapy, which will circumvent the need for surgeries and improve patient outcome. In conclusion, AGID, a disease at the interface of clinical immunology and neurogastroenterology, requires further investigations and warrants cooperation among specialists, especially clinical immunologists, gastroenterologists, and neurologists.

DOI： 10.1080/25785826.2020.1797319

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIM: Currently, there are no established biomarkers to differentiate between glucocorticoid (GC)-resistant and GC-sensitive ulcerative colitis (UC); however, interleukin (IL)-1β could be one such candidate biomarker. The aim of this study was to investigate whether mucosally expressed IL-1β could predict the response to GC in patients with UC. METHODS: A total of 27 mucosal tissue samples from 10 patients with GC-resistant UC (GC-resistant group), 9 patients with GC-sensitive UC (GC-sensitive group), and 8 control patients (control group) were analyzed by qRT-PCR for the expression of IL-1β, GC receptor α (GRα), GRβ, and other inflammatory mediators. Rachmilewitz endoscopic index (REI) between the GC-resistant and GC-sensitive groups was matched to avoid any potential influence of inflammation. RESULTS: The REI did not significantly differ between the GC-resistant and GC-sensitive groups. Mucosally expressed IL-1β levels in the GC-resistant group were significantly higher than those in the GC-sensitive group. However, there were no significant differences in the expression levels of GRα, GRβ, and other inflammatory mediators between the 2 groups. We could distinguish between the GC-resistant and GC-sensitive groups with a sensitivity of 90.0&#37; and specificity of 77.8&#37; based on mucosally expressed IL-1β. CONCLUSIONS: Mucosally expressed IL-1β can be used as a predictor of GC response in patients with UC.

DOI： 10.1159/000507435

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The Clutch Cutter was invented as a scissor-type knife for endoscopic submucosal dissection (ESD) of gastrointestinal neoplasms. ESD with the scissor-type knife (ESD-S) may be considered a technically easier procedure than ESD with non-scissor-type knives (ESD-NS). Therefore, this study aimed to compare the technical outcomes of ESD-S with those of ESD-NS for superficial esophageal cancer. This was a multicenter retrospective study. Patients with superficial esophageal cancer treated with ESD between October 2015 and March 2018 at three hospitals were retrospectively reviewed. The ESD-S group had 48 patients and the ESD-NS group had 114 patients. A propensity score matching analysis was performed to compensate for the confounding bias between both groups. Multivariate analyses and propensity score matching were used to adjust for age, sex, the tumor size, tumor location, tumor depth, degree of tumor circumference, operator level, usage of the traction method, and the sedation method. The primary outcome was the procedure time of the ESD. Secondary outcomes were the rate of en-bloc/complete resection and the rate of complications including perforation, delayed bleeding, and stricture. Propensity score matching analysis provided 36 matched pairs. Median procedure time in the ESD-S group was significantly shorter than that in the ESD-NS group (44.0 min vs. 66.5 min, P = 0.020). In addition, the treatment outcomes were similar in both groups (en-bloc resection: 100&#37; vs. 97.2&#37;, P = 1; complete resection: 88.9&#37; vs. 86.1&#37;, P = 1; curative resection: 80.6&#37; vs. 77.8&#37;, P = 1; perforation: 0&#37; vs. 5.6&#37;, P = 0.49; delayed bleeding: 0&#37; in both groups; stricture: 2.8&#37; vs. 8.3&#37;, P = 0.61). ESD-S was associated with a shorter procedure time than ESD-NS, without an increase in the incidence of complications. Therefore, the scissor-type knife should be considered as an endo-knife for ESD of superficial esophageal cancers.

DOI： 10.1093/dote/doz077

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background/Aims: It is important to appropriately manage patients with procedure-related artificial mucosal ulcers or procedure-related complications. Many endoscopic closure techniques have been reported; however, they often require the use of special devices. We developed a single-channel endoscopic closure technique (SCCT) that can be performed with conventional devices. In the present study, we describe the technique and evaluate its efficacy. Methods: Twenty-five consecutive patients who underwent endoscopic treatment and whose artificial ulcer was closed using the SCCT were enrolled in this study. The technical success rate, number of clips for closure, procedure time, complication rate on the day of the procedure, clinical success rates on days 1 and 5, and incidence of severe stenosis of the gastrointestinal (GI) tract at 2 months after the procedure were evaluated. Results: The median ulcer diameter was 20 mm. The tumor locations were the stomach (n = 19), jejunum (n = 1), and colon (n = 5). The technical success rate was 100&#37; (25/25), and the rate of incomplete closure was 0&#37; (0/25). Eight clips were needed on average. The median procedure time was 18 min (range 5-49 min). The complication rate was 0&#37; (25/25). The clinical success rates on days 1 and 5 were 100&#37; (19/19) and 100&#37; (9/9), respectively. No patients presented stenosis as a late complication at 2 months after the procedure (0/25). Conclusion: The SCCT could be applied in the treatment of artificial ulcers in several parts of the GI tract with a high clinical success rate and no complications. The SCCT appears to be a good option for closing artificial mucosal ulcers.

DOI： 10.1159/000503994

記述言語：英語  

A 43-year-old man with rheumatic arthritis was admitted to our hospital for symptoms of cough, left chest pain, and left elbow pain, and further examination revealed an elevated level of C-reactive protein. On day 2 after admission, he underwent esophagogastroduodenoscopy. On the morning of day 7, he developed a high fever of 39.7°C, several hours after bronchoscopy. On day 13, he underwent colonoscopy. Five minutes after the colonoscopy, he developed a high fever of 39.9°C, accompanied by stridor, indicating a decrease in arterial oxygen saturation level. An intradermal test for peracetic acid which was used for cleaning flexible endoscopy was positive. We suspect that he suffered from an allergic reaction to peracetic acid following the flexible endoscopy. This is the first case reported on suspicious allergic reaction to peracetic acid following a flexible endoscopy procedure.

DOI： 10.5946/ce.2019.129

記述言語：英語   掲載種別：研究論文（学術雑誌）  

ARID1A, one of the subunits in SWI/SNF chromatin remodeling complex, is frequently mutated in gastric cancers with microsatellite instability (MSI). The most frequent MSI in solid-type poorly differentiated adenocarcinoma (PDA) has been reported, but the SWI/SNF complex status in solid-type PDA is still largely unknown. We retrospectively analyzed 54 cases of solid-type PDA for the expressions of mismatch repair (MMR) proteins (MLH1, PMS2, MSH2, and MSH6), SWI/SNF complex subunits (ARID1A, INI1, BRG1, BRM, BAF155, and BAF170) and EBER, and mutations in KRAS and BRAF. We analyzed 40 cases of another histological type of gastric cancer as a control group. The solid-type PDAs showed coexisting glandular components (76&#37;), MMR deficiency (39&#37;), and complete/partial loss of ARID1A (31&#37;/7&#37;), INI1 (4&#37;/4&#37;), BRG1 (48&#37;/30&#37;), BRM (33&#37;/33&#37;), BAF155 (13&#37;/41&#37;), and BAF170 (6&#37;/2&#37;), EBER positivity (4&#37;), KRAS mutation (2&#37;), and BRAF mutation (2&#37;). Compared to the control group, MMR deficiency and losses of ARID1A, BRG1, BRM, and BAF155 were significantly frequent in solid-type PDAs. Mismatch repair deficiency was associated with the losses of ARID1A, BRG1, and BAF155 in solid-type PDAs. In the MMR-deficient group, solid components showed significantly more frequent losses of ARID1A, BRG1, BRM, and BAF155 compared to glandular components (P = .0268, P = .0181, P = .0224, and P = .0071, respectively). In the MMR-proficient group, solid components showed significantly more frequent loss of BRG1 compared to glandular components (P = .012). In conclusion, solid-type PDAs showed frequent losses of MMR proteins and the SWI/SNF complex. We suggest that loss of the SWI/SNF complex could induce a morphological shift from differentiated-type adenocarcinoma to solid-type PDA.

DOI： 10.1111/cas.14301

記述言語：英語  

DOI： 10.1055/a-0992-8900

記述言語：日本語  

症例は46歳女性で、42歳時に慢性心房細動を指摘され、ワルファリン2mg内服を継続していた。受診3日前から腹痛、食欲不振が出現し、症状が持続するため当科受診した。血液生化学検査で白血球増多、低蛋白血症、低ナトリウム血症、PT-INR延長を認めた。腹部造影CTで近位空腸に全周性連続性の腸管壁肥厚と周囲脂肪織混濁を認めた。経口的シングルバルーン小腸内視鏡検査(第1病日)では、トライツ靱帯付近より暗紫色の粘膜が出現し、粘膜下腫瘤様隆起と発赤調粘膜が連続し、肛門側では内腔狭小化を認めた。凝固能低下に伴う小腸壁内血腫と診断し、保存的加療を行う方針とした。凝固能改善のためビタミンK投与を行い、ワルファリンは休薬とした。第2病日にはPT-INR 1.37と低下、ワルファリン1mgより内服再開、PT-INRコントロールを継続した。保存的治療によって、徐々に腹痛は改善を認めた。第8病日の経口的シングルバルーン小腸内視鏡検査では、粘膜発赤は軽度残存していたが、粘膜下腫瘤様隆起は消失し、粘膜浮腫・色調の改善を認めた。内視鏡下小腸X線検査でも、腸管狭窄、浮腫は改善し、造影剤の通過は良好となった。腹痛症状の改善のみならず、内視鏡所見上も改善を認め、第9病日に退院となった。

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) of recurrent esophageal carcinoma is technically difficult to perform due to submucosal fibrosis that develops after definitive chemoradiation therapy. Therefore, our aim was to evaluate the usefulness of clip-with-thread traction for ESD of esophageal lesions with submucosal fibrosis. MATERIALS AND METHODS: Four endoscopists excised 16 lesions by ESD in an ex vivo pig training model. Mock lesions (30 mm in diameter) were created, including a 10-mm area of submucosal fibrosis in the center of each lesion. Each endoscopist performed two ESDs with traction (ESD-T) and two without traction (ESD-N). The primary outcome was the time required for submucosal dissection. Secondary outcomes were the rate of en bloc (complete) resection and perforation during the procedure, and the total amount of solution injected. RESULTS: All esophageal ESDs were completed. The median dissection time was significantly shorter for the ESD-T group (median 12.5 min, interquartile range 10.2-14.5) when comparing to the ESD-N group (median 18.0 min, interquartile range 14.6-19.2) (P=0.040). The en bloc resection rate was 100&#37; in both groups, with a rate of complete resection of 87.5&#37; and a rate of perforation of 37.5&#37; for both groups. The median amount of solution injected was not significantly different between the ESD-T (18.0 ml) and ESD-N (20.5 ml) groups (P=0.526). CONCLUSION: Clip-with-thread traction improved the performance of ESD for lesions with submucosal fibrosis. However, the method might not reduce the risk of perforation, which remains an important clinical issue to resolve.

DOI： 10.5152/tjg.2020.19207

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2020 The Author(s). Background: Gastric subepithelial lesions, including gastrointestinal stromal tumors, are often found during routine gastroscopy. While endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) has been the gold standard for diagnosing gastric subepithelial lesions, alternative open biopsy procedures, such as mucosal incision-assisted biopsy (MIAB) has been reported useful. The aim of this study is to evaluate the efficacy of MIAB for the diagnosis of gastric SELs compared with EUS-FNAB. Methods: We retrospectively analyzed medical records of 177 consecutive patients with gastric SELs who underwent either MIAB or EUS-FNAB at five hospitals in Japan between January 2010 and January 2018. Diagnostic yield, procedural time, and adverse event rates for the two procedures were evaluated before and after propensity-score matching. Results: No major procedure-related adverse events were observed in either group. Both procedures yielded highly-accurate diagnoses once large enough samples were obtained; however, such successful sampling was more often accomplished by MIAB than by EUS-FNAB, especially for small SELs. As a result, MIAB provided better diagnostic yields for SELs smaller than 20-mm diameter. The diagnostic yields of both procedures were comparable for SELs larger than 20-mm diameter; however, MIAB required significantly longer procedural time (approximately 13 min) compared with EUS-FNAB. Conclusions: Although MIAB required longer procedural time, it outperformed EUS-FNAB when diagnosing gastric SELs smaller than 20-mm diameter.

DOI： 10.1186/s12876-020-1170-2

記述言語：日本語  

78歳男性。腹痛を主訴に受診。上部消化管内視鏡検査で十二指腸下行部に多数のびらんを伴う浮腫状変化を認めた。入院3日目、四肢に紫斑が出現し、十二指腸生検病理所見で壊死性血管炎を認め、IgA血管炎と診断した。入院6日目腹部所見が増悪し、閉塞起点を伴わないイレウスを認め、機能的イレウスと診断後にイレウスチューブを挿入した。その後プレドニゾロン投与で症状及び消化管・皮膚所見は改善した。消化管の内視鏡像及び内視鏡組織生検所見が本症の診断に有用となり、腸重積または腸穿孔を伴わないイレウスを合併したIgA血管炎の1例を経験したので報告する。(著者抄録)

記述言語：その他  

DOI： 10.1111/den.13476

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. Background: An altered gastrointestinal barrier function is reportedly associated with the pathogenesis of functional dyspepsia (FD); however, the pathogenesis of FD has not yet been fully elucidated. Aims: The objective of the present study was to determine whether the mucosal barrier function is impaired in patients with FD and to investigate the mechanisms underlying FD. Methods: The present study included patients with FD (FD group, n = 24), non-FD patients with abdominal symptoms (symptomatic control group, n = 14), and patients with no abdominal symptoms (asymptomatic control group, n = 20). The groups were compared regarding the mucosal electrical impedance (MI) values of the stomach and duodenum, which were measured using a tissue conductance meter during esophagogastroduodenoscopy. Results: There were no significant differences between the three groups in the MI of the stomach. In contrast, the duodenal MI of the FD group (17.8 ± 4.3 Ω) was significantly lower than those of the symptomatic control group (27.2 ± 6.4 Ω, p < 0.0001) and asymptomatic control group (23.0 ± 7.4 Ω, p = 0.016). The expression of zonula occludens-1 (ZO-1) was significantly lower in the FD group than in the symptomatic control group (p = 0.011), where ZO-1 was positively correlated with the duodenal MI (β = 0.513, p = 0.017). The interleukin (IL)-1β expression was significantly higher in the FD group than in the symptomatic control group (p = 0.041), where IL-1β was inversely correlated with the duodenal MI (β = − 0.600, p = 0.004). Conclusions: The mucosal barrier function of the duodenum was altered in patients with FD. Both a decreased ZO-1 and increased IL-1β may play a role in the pathogenesis of FD.

DOI： 10.1007/s10620-019-5470-8

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2019 American Society for Gastrointestinal Endoscopy Background and aims: The Clutch Cutter (CC) can grasp, pull, coagulate, and incise targeted tissue with the use of electrosurgical current. It was developed as a biopsy technique to reduce the technical difficulty of endoscopic submucosal dissection (ESD) with knives. The aim of this study was to evaluate the efficacy and safety of ESD using the CC (ESD-CC) for early colorectal epithelial neoplasms (ECENs). Methods: In this prospective study, we enrolled 437 consecutive patients with a diagnosis of ECEN between January 2009 and January 2018. They all satisfied the Japanese colorectal cancer treatment guidelines for ESD; namely, confirmation by preliminary endoscopy, EUS, and endoscopic biopsy. The CC was used for all steps of ESD (mucosal incision, submucosal dissection, and hemostatic treatment); therapeutic efficacy and safety were assessed. Results: The en bloc resection rate was 99.3&#37; (434/437), and the R0 resection rate was 87.0&#37; (380/437). The mean operating time was 88.3 minutes. Perforation occurred in 10 cases (2.3&#37;) and was managed with conservative medical treatment. Post-ESD-CC bleeding occurred in 10 cases (2.3&#37;) and was successfully treated by endoscopic hemostatic treatment. Conclusions: ESD-CC is a technically efficient, safe, and easy method for resecting ECEN.

DOI： 10.1016/j.vgie.2019.05.003

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2019 Japan Gastroenterological Endoscopy Society Background and Aim: The Japan Narrow-Band Imaging (NBI) Expert Team (JNET) classification is a recently proposed NBI magnifying endoscopy-based classification system for colorectal tumors. Although the usefulness of this system has been reported by JNET experts, its objective validity remains unclear. We tested its validity and usefulness for the diagnosis of colorectal polyps by including colonoscopy experts and non-experts as test participants. Methods: Forty NBI images of polyps of various JNET types were shown to 22 doctors (11 experts and 11 non-gastrointestinal [GI] trainees) who had not examined the patients. The doctors diagnosed the polyps based solely on the surface and vessel patterns in the magnified images and the JNET classification system. Concordance rates of their diagnoses with the pathological findings of the polyps were determined, and the results for experts and non-GI trainees were compared. Results: Both for colonoscopy experts and non-GI trainees, the JNET classification system was particularly useful for classifying polyps as benign or malignant. Although the accuracy rates for classifying polyps into each JNET type varied among colonoscopy experts, those who were familiar with the JNET classification system were able to diagnose polyps with approximately 90&#37; accuracy. Common mistakes were attributable to misunderstandings of the wording in the JNET classification chart and lack of proper training. Conclusion: The JNET classification system is a practical approach for the diagnosis of colorectal polyps. Training is required even for experienced colonoscopists to adopt the system properly. Common pitfalls must be shared among colonoscopists to improve the accuracy of the diagnosis.

DOI： 10.1111/den.13393

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2019 Elsevier B.V. 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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2019 Japan Gastroenterological Endoscopy Society Objectives: This study aimed to compare the diagnostic yield of mucosal incision-assisted biopsy (MIAB) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with a rapid on-site evaluation (ROSE) for gastric subepithelial lesions (SEL) suspected of being gastrointestinal stromal tumors (GIST) with an intraluminal growth pattern. Methods: This was a prospective randomized, cross-over multicenter study. The primary outcome was the diagnostic yield of EUS-FNA and MIAB. The secondary outcomes were the technical success rate, complication rate, procedure time and biopsy frequency. Results: A total of 47 patients were randomized to the MIAB group (n = 23) and EUS-FNA group (n = 24). There was no significant difference in the diagnostic yield of MIAB and EUS-FNA (91.3&#37; vs 70.8&#37;, P = 0.0746). The complication rates of MIAB and EUS-FNA did not differ to a statistically significant extent. The mean procedure time in the MIAB group was significantly longer than that in the EUS-FNA group (34 vs 26 min, P = 0.0011). Conclusions: The diagnostic yield of MIAB was satisfactorily as high as EUS-FNA with ROSE for gastric SEL with an intraluminal growth pattern.

DOI： 10.1111/den.13367

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2019 The Cancer Genome Atlas Research Network classified gastric adenocarcinoma into four molecular subtypes: (1) Epstein-Barr virus–positive (EBV), (2) microsatellite-instable (MSI), (3) chromosomal instable (CIN), and (4) genomically stable (GS). The molecular subtypes of gastric hepatoid adenocarcinomas are still largely unknown. We analyzed 52 hepatoid adenocarcinomas for the expression of surrogate markers of molecular subtypes (MLH1, p53, and EBER in situ hybridization) and some biomarkers (p21, p16, Rb, cyclin D1, cyclin E, β-catenin, Bcl-2, IMP3, ARID1A and HER2), and mutations of TP53, CTNNB1, KRAS, and BRAF. We analyzed 36 solid-type poorly differentiated adenocarcinomas as a control group. Hepatoid adenocarcinomas were categorized as follows: EBV group (EBER-positive), no cases (0&#37;); MSI group (MLH1 loss), three cases (6&#37;); “CIN or GS” (CIN/GS) group (EBER-negative, MLH1 retained), 49 cases (94&#37;). In the CIN/GS group, most of the tumors (59&#37;) had either p53 overexpression or TP53 mutation and a coexisting tubular intestinal-type adenocarcinoma component (90&#37;), suggesting that most hepatoid adenocarcinomas should be categorized as a true CIN group. Hepatoid adenocarcinomas showed relatively frequent expressions of HER2 (score 3+/2+: 21&#37;/19&#37;). Hepatoid adenocarcinomas showed shorter survival, more frequent overexpressions of p16 (67&#37;) and IMP3 (98&#37;) than the control group. None of hepatoid adenocarcinomas had KRAS or CTNNB1 mutations except for one case each, and no hepatoid adenocarcinomas had BRAF mutation. In conclusion, gastric hepatoid adenocarcinomas are a genetically heterogenous group. Most hepatoid adenocarcinomas are “CIN,” but a small number of hepatoid adenocarcinomas with MSI do exist. Hepatoid adenocarcinomas are characterized by overexpressions of p16 and IMP3.

DOI： 10.1016/j.humpath.2019.03.006

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: The aim of this study was to evaluate the difficulty of endoscopic retrograde cholangiopancreatography (ERCP) procedures when performed in patients with different types of surgically altered gastrointestinal (GI) anatomies. Summary of background data: Clinical data of 102 consecutive patients with surgically altered GI anatomy who underwent ERCP using a double-balloon enteroscope or a regular gastroendoscope between January 2008 and March 2015 were retrospectively reviewed. Methods: The success rate of reaching the destination, the time until reaching the destination, the success rate of the procedures, and complications were assessed for each type of altered GI anatomy using a double-balloon enteroscope and a regular gastroendoscope. Results: A total of 180 ERCP procedures were performed. The total success rate of reaching the destination was 91% (164 of 180), and that of treatment was 88% (144 of 164). The success rate of reaching the destination in patients with Roux-en-Y hepaticojejunostomy (HJ þ R-Y) was significantly lower than that of the other types of reconstruction. The time until reaching the destination was significantly longer in patients after R-Y reconstruction (gastrectomy or HJ) than that after Billroth-II gastrectomy or pancreatoduodenectomy. GI perforation occurred in 2 patients after R-Y reconstruction (1 patient after gastrectomy, and 1 patient after HJ). However, no other complications, such as severe pancreatitis, bleeding, or air embolism, were observed. Conclusions: ERCP for patients with surgically altered GI anatomy is feasible. Improvement of the success rate of reaching the destination in patients after HJ þ R-Y and prevention of perforation in those with R-Y reconstruction are necessary.

DOI： 10.9738/INTSURG-D-17-00137.1

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2018, Japanese Society of Gastroenterology. Background: The existence of several autoantibodies suggests an autoimmune basis for gastrointestinal (GI) dysmotility. Whether GI motility disorders are features of autoimmune autonomic ganglionopathy (AAG) or are related to circulating anti-ganglionic acetylcholine receptor (gAChR) antibodies (Abs) is not known. The aim of this study was to determine the associations between autonomic dysfunction, anti-gAChR Abs, and clinical features in patients with GI motility disorders including achalasia and chronic intestinal pseudo-obstruction (CIPO). Methods: First study: retrospective cohort study and laboratory investigation. Samples from 123 patients with seropositive AAG were obtained between 2012 and 2017. Second study: prospective study. Samples from 28 patients with achalasia and 14 patients with CIPO were obtained between 2014 and 2016, and 2013 and 2017, respectively. In the first study, we analyzed clinical profiles of seropositive AAG patients. In the second study, we compared clinical profiles, autonomic symptoms, and results of antibody screening between seropositive, seronegative achalasia, and CIPO groups. Results: In the first study, we identified 10 patients (8.1&#37;) who presented with achalasia, or gastroparesis, or paralytic ileus. In the second study, we detected anti-gAChR Abs in 21.4&#37; of the achalasia patients, and in 50.0&#37; of the CIPO patients. Although patients with achalasia and CIPO demonstrated widespread autonomic dysfunction, bladder dysfunction was observed in the seropositive patients with CIPO as a prominent clinical characteristic of dysautonomia. Conclusions: These results demonstrate a significant prevalence of anti-gAChR antibodies in patients with achalasia and CIPO. Anti-gAChR Abs might mediate autonomic dysfunction, contributing to autoimmune mechanisms underlying these GI motility disorders.

DOI： 10.1007/s00535-018-1477-8

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© The Author(s) 2018. 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

記述言語：英語  

DOI： 10.1055/a-0631-7760

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2018, Japanese Society of Gastroenterology. There have been no reports of primary leiomyosarcoma of the stomach treated by endoscopic submucosal dissection (ESD). We report an extremely rare case of gastric leiomyosarcoma that was successfully treated by ESD. An asymptomatic 74-year-old female underwent esophagogastroduodenoscopy for screening in December 2013. A centrally depressed submucosal tumor 10 mm in diameter was detected at the posterior wall of the upper gastric body. Follow-up esophagogastroduodenoscopy conducted 5 months later showed that the tumor diameter had increased to 15 mm. Endoscopic ultrasound revealed a hypoechoic mass located in the second to the middle of the third layer. Endoscopic ultrasound-guided fine-needle aspiration demonstrated a myogenic tumor. The tumor was completely resected by ESD without complications. Immunohistopathological diagnosis of the resected specimen was gastric leiomyosarcoma derived from the muscularis mucosae, with negative lateral and vertical margins. No local recurrence or metastasis has been detected at 36 months after ESD. This is the first report of gastric leiomyosarcoma treated by ESD in the English language literature.

DOI： 10.1007/s12328-018-0838-4

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2018 The Author(s). Background: Endoscopic submucosal dissection (ESD) of the postoperative stomach (ESD-P) for early gastric cancer (EGC) is considered a technically difficult procedure. However, it is difficult to compare the outcomes of ESD-P and ESD of the non-operative stomach (ESD-N) because their baseline characteristics are different. Therefore, we aimed to compare the technical outcomes of ESD-P with those of ESD-N using a propensity score-matching analysis to compensate for the differences. Methods: The chart records of 1046 patients with EGC who were treated with ESD between January 2004 and July 2016 at Kitakyushu Municipal Medical Center in Japan were reviewed in this retrospective study. Multivariate analyses and propensity score-matching were performed for age, sex, lesion location, lesion size, tumor invasion, tumor size, ulcer (scar), and operator skill. The primary outcome was procedure time. Secondary outcomes were percentages of en bloc, complete, and curative resections, and percentages of adverse events, which were evaluated between the two groups. Results: Forty-one patients were in the ESD-P group and 1005 patients were in the ESD-N group. Propensity score-matching created 41 matched pairs. According to the adjusted comparisons, ESD-P required a significantly longer procedure time (85 min vs 51 min, p < 0.001). Other treatment outcomes showed an en bloc resection rate of 100&#37; for both groups (p = 1) and complete resection rates of 95.1 and 97.6&#37; (p = 1), curative resection rates of 90.2 and 90.2&#37; (p = 1), perforation during ESD rates of 2.4 and 0&#37; (p = 1), and postprocedure bleeding rates of 2.4 and 2.4&#37; (p = 1) for the ESD-P and ESD-N groups, respectively. For the ESD-P group, lesions on the suture line or anastomotic site were significantly associated with longer procedure times (p = 0.038). Conclusions: ESD-P was a more time-consuming procedure than ESD-N. However, ESD-P and ESD-N achieved high rates of curative resection with a low rate of adverse events for the treatment of EGC. ESD could be selected as the treatment for EGC even in the postoperative stomach provided that careful attention is given to lesions on the suture line or anastomotic site.

DOI： 10.1186/s12876-018-0855-2

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2018, The Author(s). Imaging of a 53-year-old Japanese man revealed two tumors in the liver and a tumor in the head of the pancreas with a swelling lymph node. A needle biopsy for the liver tumors was performed, revealing a neuroendocrine tumor. Enucleation, lymphadenectomy, and partial hepatectomy were performed. The microscopic examination identified many tumor cells with intracytoplasmic inclusions arranged in a nested, cord, or tubular fashion. The intracytoplasmic inclusions displayed densely eosinophilic globules and displaced the nuclei toward the periphery, which constitutes “rhabdoid” features. The tumor cells were positive for synaptophysin and weakly positive for NCAM, but negative for chromogranin A. Epithelial markers (AE1/AE3 and CAM5.2) accentuated intracytoplasmic globules. Pancreatic neuroendocrine tumors with rhabdoid features are very rare. Generally, rhabdoid features are aggressive and dedifferentiated characteristics of various types of tumor. Pancreatic neuroendocrine tumors containing rhabdoid cells tend to display extrapancreatic spread at the time of presentation, although some of these tumors with rhabdoid features are not always associated with aggressive behavior.

DOI： 10.1007/s00428-018-2398-x

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2018 S. Karger AG, Basel. Copyright: All rights reserved.ing, or by any information storage and retrieval system, without permission in writing from the publisher. Background and Aim: Although basic research has shown that certain cytokines affect gastrointestinal motility, the clinical evidence is lacking. The objective of this study was to explore the association between mucosally expressed cytokines and the esophageal motility function in humans. Methods: We enrolled a total of 57 patients with suspected esophageal motility disorders (EMDs) who underwent high-resolution manometry. Results: The diagnoses of the patients were as follows: normal esophageal motility (n = 25), ineffective esophageal motility (n = 5), esophagogastric junction outflow obstruction (EGJOO; n = 10), distal esophageal spasm (n = 5), achalasia (n = 10), absent contractility (n = 1), and jackhammer esophagus (n = 1). The expression of tumor necrosis factor (TNF)-α in the esophagogastric junction (EGJ) was significantly higher in EGJOO (14.6, 14.0-15.8, n = 10) than in normal esophageal motility (13.3, 12.8-14.1, n = 25); however, there was no difference in the expression of TNF-α between achalasia (13.4, 13.0-14.1, n = 10) and normal esophageal motility (13.3, 12.8-14.1, n = 25). EGJOO was discriminated from achalasia/normal by a linear discriminant analysis (AUC = 0.917). A multivariable regression analysis revealed that interleukin (IL)-13 and IL-23A were predictive of the distal contractile integral, whereas TNF-α and IL-6 were predictive of the basal EGJ pressure. Conclusions: The esophageal motility was associated with mucosally expressed cytokines in humans; these cytokines could be useful targets for the diagnosis and treatment of EMDs.

DOI： 10.1159/000487708

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. Background: Difficulties in endoscopic operations and therapeutic procedures seem to occur due to the complexity of operating the endoscope dial as well as difficulty in performing synchronized movements with both hands. We developed a prototype robotic-assisted flexible endoscope that can be controlled with a single hand in order to simplify the operation of the endoscope. The aim of this study was to confirm the operability of the robotic-assisted flexible endoscope (RAFE) by performing endoscopic submucosal dissection (ESD). Methods: Study 1: ESD was performed manually or with RAFE by an expert endoscopist in ex vivo porcine stomachs; six operations manually and six were performed with RAFE. The procedure time per unit circumferential length/area was calculated, and the results were statistically analyzed. Study 2: We evaluated how smoothly a non-endoscopist can move a RAFE compared to a manual endoscope by assessing the designated movement of the endoscope. Results: Study 1: En bloc resection was achieved by ESD using the RAFE. The procedure time was gradually shortened with increasing experience, and the procedure time of ESD performed with the RAFE was not significantly different from that of ESD performed with a manual endoscope. Study 2: The time for the designated movement of the endoscope was significantly shorter with a RAFE than that with a manual endoscope as for a non-endoscopist. Conclusions: The RAFE that we developed enabled an expert endoscopist to perform the ESD procedure without any problems and allowed a non-endoscopist to control the endoscope more easily and quickly than a manual endoscope. The RAFE is expected to undergo further development.

DOI： 10.1007/s00464-018-6188-y

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2018 The Authors 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

記述言語：その他   掲載種別：研究論文（学術雑誌）  

A 73-year-old female with a medical history of total gastrectomy and Roux-en-Y reconstruction was admitted to our hospital for epigastric pain. Contrast-enhanced abdominal computed tomographic (CT) scan showed a markedly dilated afferent loop with suspected anastomotic obstruction, leading to the diagnosis of afferent loop syndrome. Anastomosis stricture was so severe that we could not initially identify the anastomosis site by esophagogastroduodenoscopy, but we finally found the pinhole-like anastomosis site with leakage of yellowish-white liquid by the aid of an endoscopic distal attachment. Endoscopic balloon dilation was performed for the pinhole-like anastomosis stricture, and after that a large amount of intestinal juice flowed out through the dilated hole. Her symptoms improved together with resolution of the dilated afferent loop. Endoscopic balloon dilation is an effective treatment for afferent loop syndrome, and CT scan and attentive endoscopic examination are useful to identify the anastomosis site in such cases.

DOI： 10.11280/gee.60.131

記述言語：日本語  

症例は73歳、女性。5年前に胃癌に対して胃全摘術、Roux-en-Y再建術を受けており、心窩部痛を主訴に当院へ救急搬送された。腹部造影CT検査でY脚全体の腸管拡張を認め、Y脚吻合部は盲端に終わっていた。輸入脚症候群と診断し緊急上部消化管内視鏡検査を行い、粘膜のわずかな引きつれと黄白色液漏出を手掛かりにpin hole状のY脚吻合部を同定しえた。同部に対し内視鏡的バルーン拡張術を施行すると大量の腸液流出を認めた。術後経過は良好で第6病日に退院となった。輸入脚症候群に対しては内視鏡的拡張術が極めて有効であり、CT検査による全体像把握に加え詳細な内視鏡観察によりY脚吻合部を同定することが有用である。(著者抄録)

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2018 The Author(s). Background: Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer. A new multi-functional ESD device was developed to achieve complete ESD with a single device. A metal plate attached to its distal sheath achieves better hemostasis during the procedure than the other needle-knife device, Flush Knife BT®, that has been conventionally used. The aim of this study was to compare the technical outcomes of ESD for early gastric cancer using the Splash M-Knife® with those using the Flush Knife BT. Methods: We conducted a retrospective review of the case records of 149 patients with early gastric cancer treated with ESD using the needle-type ESD knives between January 2012 and August 2016 at Kitakyushu Municipal Medical Center. Lesions treated with ESD using the Splash M-knife (ESD-M) and the Flush Knife BT (ESD-F) were compared. Multivariate analyses and propensity score matching were used to compensate for the differences in age, gender, underlying disease, antithrombotic drug use, lesion location, lesion position, macroscopic type, tumor size, presence of ulceration, operator level and types of electrosurgical unit used. The primary endpoint was the requirement to use hemostatic forceps in the two groups. The secondary endpoints of procedure time, en bloc and complete resection rates, and adverse events rates were evaluated for the two groups. Results: There were 73 patients in the ESD-M group, and 76 patients in the ESD-F group. Propensity score matching analysis created 45 matched pairs. Adjusted comparisons between the two groups showed a significantly lower usage rate of hemostatic forceps in the ESD-M group than in the ESD-F group (6.7&#37; vs 84.4&#37;, p<0.001). Treatment outcomes showed an en bloc resection rate of 100&#37; in both groups; complete resection rate of 95.6&#37; vs 100&#37;, p=0.49; median procedure time of 74.0 min vs 71.0 min, p=0.90; post-procedure bleeding of 2.2&#37; vs 2.2&#37;, p=1, in the ESD-M and ESD-F groups, respectively. There were no perforations in either group. Conclusions: ESD-M appeared to reduce the usage of hemostatic forceps during ESD for early gastric cancer without increasing the adverse effects. Thus, it may contribute to a reduction in the total ESD cost.

DOI： 10.1186/s12876-018-0763-5

記述言語：英語   掲載種別：研究論文（学術雑誌）  

S

DOI： 10.1097/PAS.0000000000000947

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© The Author(s) 2017. AIM To evaluate the clinical outcome of endoscopic subSubmitmucosal dissection using the Clutch Cutter (ESDCC) in older patients. METHODS We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC between June 2010 and February 2014 at Aso Iizuka Hospital. We divided patients into two groups according to age: Older patients ( > 80 years, n = 64) and non-older patients (= 80 years, n = 168). We retrospectively compared the prevalence rates of pre-existing comorbidities, anticoagulant therapy, en bloc resection, mean duration of hospitalization, incidence of ESDCC-related complications, change in performance status (PS) before and after ESDCC, and financial cost of admission. RESULTS The older group comprised 64 patients with a mean age of 84.1 years, and the non-older group comprised 168 patients with a mean age of 69.5 years. Older patients had significantly more pre-existing comorbidities than did non-older patients, specifically heart disease (P < 0.05). The en bloc resection rate in non-older patients was significantly higher than that in older patients (100&#37; vs 95.3&#37;, P = 0.02). There were no significant differences between the older and non-older groups in the incidence of ESDCC-related complications (i.e., postoperative bleeding and perforation) and the post-ESDCC change in PS. There were also no significant differences between the older and non-older groups in the mean duration of hospitalization (11.4 and 10.7 d, respectively) and financial cost of admission (657040 JPY and 574890 JPY, respectively). CONCLUSION ESDCC has a good clinical outcome in older patients.

DOI： 10.4251/wjgo.v9.i10.416

記述言語：英語  

AIM: To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) using the clutch cutter (CC) (ESD-CC) for gastric adenoma (GA). METHODS: From June 2007 to August 2015, 122 consecutive patients with histological diagnoses of GA from specimens resected by ESD-CC were enrolled in this prospective study. The CC was used for all ESD steps (marking, mucosal incision, submucosal dissection, and hemostatic treatment), and its therapeutic efficacy and safety were assessed. RESULTS: Both the en-bloc resection rate and the R0 resection rate were 100&#37; (122/122). The mean surgical time was 77.4 min, but the time varied significantly according to tumor size and location. No patients suffered perforation. Post-ESD-CC bleeding occurred in six cases (4.9&#37;) that were successfully resolved by endoscopic hemostatic treatment. CONCLUSION: ESD-CC is a technically efficient, safe, and easy method for resecting GA.

DOI： 10.4253/wjge.v9.i7.334

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2016, Japanese Society of Gastroenterology. Background: T helper (Th) and regulatory T (Treg) cell-related cytokines are implicated in inflammatory bowel diseases, including ulcerative colitis (UC). While these cytokines are generally upregulated in inflamed mucosae, the key cytokine profile explaining disease severity has not been determined. Methods: The Rachmilewitz endoscopic index (REI) was assessed in 61 UC patients undergoing colonoscopy. Biopsies obtained from inflamed (REI 3–12) and noninflamed (REI 0–2) areas were analyzed by quantitative PCR for expression of mRNAs encoding cytokines and transcription factors related to Th1 (TNF-α, IFN-γ, IL-12p35, IL-12p40, and T-bet), Th2 (IL-4, IL-13, IL-33, and GATA3), Th17 (IL-17A, IL-17F, IL-21, IL-22, IL-23p19, IL-6, and RORC), Th9 (IL-9, IRF4, and PU.1), and Treg (TGF-β and Foxp3). Expression patterns associated with higher REI were determined by univariate and multivariate analyses. Results: Despite general upregulation, none of these mRNAs showed univariate correlation with REI in inflamed samples. Multiple regression analysis, however, found that joint expression of IL-17A, IL-17F, IL-21, RORC, and TGF-β was significantly predictive of REI (P < 0.0002, R2 = 0.380), with major individual contributions by IL-17A (P < 0.0001) and IL-17F (P < 0.0001), which were associated with increased and decreased REI, respectively. Partial correlation analysis, validating this model, indicated differences between IL-17A and IL-17F in correlating with other targets. The IL-17A/IL-17F ratio showed a significant correlation with REI (r = 0.5124, P < 0.0001), whereas no other mRNAs were essentially predictive of REI. Conclusions: Mucosal IL-17A/IL-17F ratio significantly correlates with endoscopic score in UC patients, accompanied by their disparate interactions with other Th/Treg-related genes.

DOI： 10.1007/s00535-016-1221-1

記述言語：日本語  

症例は60歳代男性。上部消化管内視鏡検査で胃穹窿部に13mm大の胃神経内分泌腫瘍を認め、血清ガストリン値は3376pg/mlと高値であった。内視鏡を含む検査所見、また抗Helicobacter pylori抗体陽性より、A型胃炎、ガストリノーマは考えにくく、B型胃炎にともなうものと考えられた。高ガストリン血症をともない発生する胃神経内分泌腫瘍でB型胃炎を背景とするものはまれであり、さらなる症例の集積が望まれる。(著者抄録)

記述言語：英語  

© 2016 S. Karger AG, Basel. Background: Based on Chicago Classification version 3.0, the disorders of esophagogastric junction outflow obstruction (EGJOO) include achalasia (types I, II and III) and EGJOO. Although no curative treatments are currently available for the treatment of the disorders of EGJOO, medical treatments, endoscopic pneumatic dilation (PD), laparoscopic Heller myotomy (LHM), and per-oral endoscopic myotomy (POEM) are usually the sought-after modes of treatment. Since the etiology and pathogenesis might vary depending on the types of EGJOO disorders, treatment strategies should be considered based on those subtypes. Summary: Based on the accumulated evidences, the treatment strategies of our institution are as follows: effects of medical treatments on achalasia are limited. Either PD or LHM/POEM can be considered a first-line in achalasia type I, according to the patient's wish. PD and POEM can be considered first-line in achalasia types II and III, respectively. Conversely, In EGJOO, medical treatments including drugs like acotiamide and/or diltiazem can be tested as a first-line, and PD and POEM will be considered second and third-line treatments, respectively. Key Messages: The classification of subtypes based on high-resolution manometry will help us consider which treatment option can be selected as a first-line treatment depending upon the subtypes of disorders of EGJOO. Acotiamide has the potential to cure patients with EGJOO.

DOI： 10.1159/000452354

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2017 Baishideng Publishing Group Inc. All rights reserved. AIM: To determine the prognostic factors associated with mortality in patients with gastric fundal variceal (GFV) bleeding. METHODS: In total, 42 patients were endoscopically diagnosed with GFV bleeding from January 2000 to March 2014. We retrospectively reviewed the patients' medical records and assessed their history, etiology of liver cirrhosis, disease conditions, treatment options for GFV bleeding, medications administered before and after onset of GFV bleeding, blood test results (hemoglobin, albumin, and bilirubin concentrations), and imaging results (including computed tomography and abdominal ultrasonography). We also assessed the prognostic factors associated with short-term mortality (up to 90 d) and long-term mortality in all patients. RESULTS: Multivariate analysis showed that prophylactic administration of antibiotics was an independent prognostic factor associated with decreases in short-term mortality (OR = 0.08, 95&#37;CI: 0.01-0.52) and long-term mortality (OR = 0.27, 95&#37;CI: 0.08-0.91) in patients with GFV bleeding. In contrast, concurrent hepatocellular carcinoma (HCC) and regular use of proton pump inhibitors (PPI) were independent prognostic factors associated with increases in short-term mortality (HCC: OR = 15.4, 95&#37;CI: 2.08-114.75; PPI: OR = 12.76, 95&#37;CI: 2.13-76.52) and long-term mortality (HCC: OR = 7.89, 95&#37;CI: 1.98-31.58; PPI: OR = 10.91, 95&#37;CI: 2.86-41.65) in patients with GFV bleeding. The long-term overall survival rate was significantly lower in patients who regularly used PPI than in those who did not use PPI (P = 0.0074). CONCLUSION: Administration of antibiotics is associated with decreased short- and long-term mortality, while concurrent HCC and regular PPI administration are associated with increased short- and long-term mortality.

DOI： 10.3748/wjg.v23.i3.496

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and study aims Endoscopic snare polypectomy with prophylactic detachable snare of large pedunculated colonic polyps (PCPs) is technically demanding. To facilitate removal of such polyps, we developed endoscopic resection using the Clutch Cutter and a detachable snare (ERCCDS). This study aimed to evaluate the efficacy and safety of the procedure. Patients and methods From April 2010 to July 2015, 14 consecutive patients who had PCPs with head > 10 mm, stalk width > 5 mm, and stalk length > 10 mm were enrolled in this single-center prospective uncontrolled study. They were treated using ERCCDS by a single endoscopist. The efficacy and safety were assessed using a database prospectively formatted from the medical records. Results The Clutch Cutter was able to cut the distal side of the stalk an adequate distance from the detachable snare under good visual control. R0 resections were obtained in all lesions. There were no immediate or delayed complications. Conclusions ERCCDS appears to be a safe, easy, and technically efficient method for large PCPs, although larger studies are needed to compare ERCCDS and standard resection.

DOI： 10.1055/s-0042-116023

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background/Aims: The ability of endoscopic submucosal dissection (ESD) to resect large early gastric cancers (EGCs) results in the need to treat large artificial gastric ulcers. This study assessed whether the combination therapy of rebamipide plus a proton pump inhibitor (PPI) offered benefits over PPI monotherapy. Methods: In this prospective, randomized, multicenter, open-label, and comparative study, patients who had undergone ESD for EGC or gastric adenoma were randomized into groups receiving either rabeprazole monotherapy (10 mg/day, n=64) or a combination of rabeprazole plus rebamipide (300 mg/day, n=66). The Scar stage (S stage) ratio after treatment was compared, and factors independently associated with ulcer healing were identified by using multivariate analyses. Results: The S stage rates at 4 and 8 weeks were similar in the two groups, even in the subgroups of patients with large amounts of tissue resected and regardless of CYP2C19 genotype. Independent factors for ulcer healing were circumferential location of the tumor and resected tissue size; the type of treatment did not affect ulcer healing. Conclusions: Combination therapy with rebamipide and PPI had limited benefits compared with PPI monotherapy in the treatment of post-ESD gastric ulcer (UMIN Clinical Trials Registry, UMIN000007435).

DOI： 10.5009/gnl15486

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2016 S. Karger AG, Basel. Background and Aim: Acotiamide is a newly developed prokinetic drug that is clinically used to treat functional dyspepsia (FD). The objective of this study was to assess the therapeutic effects of acotiamide in patients with esophageal motility disorders (EMDs). Methods: Twenty-nine patients with both symptoms of FD and symptoms suspicious of EMDs were enrolled. Esophageal motility function was evaluated by high-resolution manometry before and after 2 weeks administration of acotiamide (100 mg) 3 times per day. Results: Twenty-nine patients were diagnosed with achalasia (n = 4), esophagogastric junction outflow obstruction (EGJOO) (n = 6), absent peristalsis (n = 2), distal esophageal spasm (n = 4), frequently failed peristalsis (n = 7), weak peristalsis (n = 2) and 4 of them were found to be normal. An analysis in all 29 patients showed that acotiamide had no effects on based on distal contractile integral (DCI), basal lower esophageal sphincter (LES) pressure, or integrated relaxation pressure (IRP). Subgroup analysis, however, showed that acotiamide dramatically reduced IRP, from 19.5 (15.1-30.8) to 12.1 (5.6-16.4) mm Hg, and DCI, from 2,517.9 (1,451.0-8,385.0) to 1,872.5 (812.3-5,225.3) mm Hg·cm·s, in the 6 patients with EGJOO. Conclusions: Acotiamide potentially normalized impaired LES relaxation in patients with EGJOO, while having no effects on normal esophageal motility patterns. Acotiamide may be a promising treatment for EGJOO.

DOI： 10.1159/000447010

記述言語：日本語  

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.

記述言語：日本語  

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。

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd. 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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語  

【背景】内視鏡的粘膜下層剥離術は早期胃癌治療のスタンダードとなっている。しかしながら、80歳以上の超高齢者に適した治療であるかはいまだ明らかではない。【方法】ガイドライン絶対適応内病変と適応拡大病変と診断した89名の患者106症例を65歳以下のNE群、80歳以上のVE群とし両群の比較検討を行った。ガイドラインを満たさない18症例は適応外病変と定義した。【結果】一括完全切除率はVEとNE両群で良好であり、統計学的有意差は認めなかった。NE群と比較してVE群に虚血性心疾患の併存症と抗血栓薬の使用が多かったが、内視鏡的粘膜下層剥離術における合併症に有意差は認めなかった。適応外病変の患者18症例のうち7症例が超高齢者であり、うち2名が追加外科切除をうけ、残る5名は経過観察とした。すべての群で局所再発、遠隔転移、胃癌関連死は認めなかった。【結論】早期胃癌に対する内視鏡的粘膜下層剥離術の短期及び長期成績は超高齢者において非高齢者と同様に良好であった。(著者抄録)

記述言語：日本語  

癌の緩和医療の中でも、癌の進行・転移による消化管閉塞に対する治療の選択肢は、これまで限られていた。本邦において、悪性腫瘍による消化管閉塞に対して、従来はバイパス術や人工肛門造設術が行われてきた。しかし、QOL改善のために手術を行うことへの抵抗感は否めず、消化管の閉塞解除を少ない負担で行える方法は長らく望まれていた。近年、内視鏡技術の急速な進歩によって、消化管狭窄には自己拡張型金属ステント(self-expandable metallic stent:SEMS)留置術が開発され、全消化管に臨床導入可能となった。本稿では、食道、胃十二指腸、大腸に分けて、最近の消化管ステントの現状を概説する。(著者抄録)

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2015 Taylor & Francis. Objective Although the World Health Organisation (WHO) defined a novel classification of gastroenteropancreatic neuroendocrine tumours (NETs) in 2010, indications for endoscopic resection of rectal NETs in the guidelines were based on evidence accumulated for carcinoid tumours defined by a previous classification. This study was designed to clarify indications for endoscopic resection of rectal NETs corresponding to the new WHO classifications. Material and methods One hundred-seventy rectal NETs resected endoscopically from April 2001 to March 2012 were histologically re-classified according to the WHO 2010 criteria. The clinicopathological features of these lesions were analysed, and the short- and long-term outcomes of endoscopic resection were evaluated. Results Of the 170 rectal NETs, 166 were histopathologically diagnosed as NET G1 and four as NET G2. Thirty-eight tumours (22.4&#37;) were positive for lymphovascular invasion, a percentage higher than expected. Although the curative resection rate was low (65.3&#37;), en bloc (98.8&#37;) and complete (85.9&#37;) resection rates were high. Modified endoscopic mucosal resection (88.0&#37;) and endoscopic submucosal dissection (92.2&#37;) resulted in significantly higher complete resection rates than conventional endoscopic mucosal resection (36.4&#37;). No patient experienced tumour recurrence, despite the low curative resection rate. Conclusion Despite the low curative resection rate, prognosis after endoscopic resection of rectal NETs was excellent. Prospective large-scale, long-term studies are required to determine whether NET G2 and tumours >1 cm should be included in the indication for endoscopic resection and whether tumours with lymphovascular invasion can be followed up without additional surgery.

DOI： 10.3109/00365521.2015.1107752

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2016 Japan Gastroenterological Endoscopy Society. All Rights Reserved. A 53 - year - old man was referred to our hospital for evaluation and treatment of an ileal neuroendocrine tumor (NET). Colonoscopy revealed a xanthochromic submucosal tumor of 3 mm in diameter in the terminal ileum. It was diagnosed as NET by histological analysis of a biopsy specimen. Preoperative examinations including contrast - enhanced CT, FDG - PET and small - bowel endoscopy did not reveal synchronous or distant metastatic lesions. As a result, the patient was diagnosed as having clinical stage I (cT1, N0, M0) NET. The patient underwent segmental resection of the ileum with D3 lymph node dissection. Despite the small diameter of the tumor, the final pathological diagnosis was grade 2 ileal NET accompanied by metastasis to the ileocolic lymph nodes (#203). Surgical resection and appropriate lymph node dissection should thus be considered for the treatment of ileal NET, regardless of tumor size.

記述言語：日本語  

症例は53歳男性。下部消化管内視鏡検査にて、終末回腸に3mm程度の黄色調の粘膜下腫瘍を認め、生検にてNETと診断された。造影CT、FDG-PET及び小腸内視鏡検査では、同時多発病変や転移性病変は明らかではなく、回腸NET(cT1、N0、M0、cStage I)と診断し、回腸部分切除および3群リンパ節郭清を施行した。術後病理所見にて回腸NET G2と確定診断した。また、病変は3mm大であったが、脈管侵襲を認め、主リンパ節である回結腸根リンパ節(#203)にリンパ節転移を認めた。回腸NETの治療は、病変の大きさに関係なくリンパ節郭清を含めた腸管切除が望ましいと考えられた。(著者抄録)

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© Informa Healthcare Objective. The criteria for endoscopic resection for early gastric cancer include absolute and expanded indications. Consensus already exists for the absolute indications. However, the suitability of the expanded indications must be validated by long-term outcome analyses since such lesions have only recently become resectable with the development of endoscopic submucosal dissection. The aim of this study is to clarify the suitability of the expanded indications for the treatment of early gastric cancer with endoscopic submucosal dissection. Materials and methods. The medical records of 1161 patients with early gastric cancers (1332 lesions) treated by endoscopic submucosal dissection and meeting the criteria for absolute or expanded indications without additional treatment with gastrectomy were divided into absolute indication group or expanded indication group. Results. Complete resection rates were 96.4&#37; and 93.4&#37; in absolute and expanded indication groups, respectively, with no significant differences between the groups. Delayed bleeding rates were significantly higher in the expanded indication group, whereas all cases were successfully managed conservatively. The 5-year overall survival and recurrence-free rates were 93.7&#37;/99.77&#37; and 90.49&#37;/98.90&#37; in the absolute and the expanded indication groups, respectively, with no significant differences between the groups for either measure. Multivariate analyses revealed that affected horizontal margin and tumor location were independent predictive factors for recurrence. Conclusion. The expanded indication group showed excellent post-endoscopic submucosal dissection short-term and long-term outcomes compared with the absolute indications group, demonstrating that expanded indications are suitable for endoscopic submucosal dissection for early gastric cancer.

DOI： 10.3109/00365521.2014.940377

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2015 Elsevier B.V. All rights reserved. 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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jphs.2015.02.002

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2014 John Wiley & Sons Ltd. Background: Mitogen-activated protein kinases (MAPKs), including extracellular signal-regulated protein kinase (ERK) and p38MAPK, are known regulators of smooth muscle contractility. The contraction of smooth muscle is mainly regulated by the phosphorylation of regulatory light chains of myosin II (LC20), which is driven by the balance between myosin light chain kinase (MLCK) and myosin light chain phosphatase (MLCP). We hypothesized that one possible mechanism for MAPK-dependent modulation of intestinal smooth muscle contractility is via the regulation of MLCP activity. Methods: Contractile responses to carbachol (CCh) and effects of MAPK inhibitors on CCh-induced contractions were assessed with isolated rat ileal longitudinal smooth muscle strips. Biochemical assessments of MLCP activity and myosin phosphatse targeting subunit (MYPT1) and CPI-17 phosphorylations were completed. Key Results: Treatment of ileal smooth muscle with PD98059 (10 μM; MEK inhibitor) or SB203580 (10 μM; p38MAPK inhibitor) significantly inhibited CCh-induced contractile force. Decreased MLCP activity was observed during sustained contractions induced by CCh; the MLCP activity was recovered by treatment with PD98059 and SB203580. However, MYPT1 (Thr697 and Thr855) and CPI-17 (Thr38) phosphorylations were not affected. Application of ML-7 (MLCK inhibitor) during CCh-induced sustained contraction elicited an MLCP-dependent relaxation, the rate of which was accelerated by application of PD98059 and SB203580 with proportional changes in LC20 phosphorylation levels but not MYPT1 phosphorylation (Thr697 or Thr855). Conclusions & Inferences: ERK and p38MAPK contribute to CCh-induced sustained contraction in a LC20 phosphorylation dependent manner. Moreover, both kinases inhibit MLCP activity possibly by a novel mechanism.

DOI： 10.1111/nmo.12491

記述言語：日本語  

腸管運動能異常におけるサイトカインの平滑筋運動に及ぼす影響と大建中湯の治療効果について実験的検討を行なった。方法は抗CD3抗体をBALB/cマウスの腹腔内に投与して下痢型の機能性腸疾患モデルを作成し、大建中湯(2700mg/kg)を1日1回連日経口投与した。胃腸管輸送能をgeometric centerにより評価した結果、1)抗CD3抗体投与により一過性の腸炎が認められたが、投与後7日目以降には腸炎は終息していた。2)IL-17Aノックアウトマウスでは急性期において輸送能の顕著な低下がみられたが、終息期の輸送能の亢進は認められず、IL-17Aの腹腔内投与により輸送能の亢進がもたらされた。3)大建中湯の投与は炎症時の細胞浸潤、小腸組織のIL-17A産生誘導、終息期における輸送能の亢進を有意に抑制していた。以上より、本モデルにおける炎症終息後の腸管運動過亢進にはIL-17Aが関与している可能性が考えられ、大建中湯の投与は本モデルにおける腸管運動能異常に有効である可能性が示唆された。

記述言語：英語   掲載種別：研究論文（学術雑誌）  

© 2014 Royal Australasian College of Surgeons. Background: To reduce the risk of complications related to endoscopic submucosal dissection (ESD) using knives, we developed the Clutch Cutter (CC), which can grasp and incise the target tissue similarly to biopsy techniques using an electrosurgical current. The aim of this study was to evaluate the efficacy and safety of ESD using the CC for removal of rectal carcinoid tumours. Methods: Between December 2009 and December 2011, we prospectively enrolled seven patients (seven lesions) on 7 different days. Patients were endoscopically diagnosed with rectal subepithelial lesions (upper rectum, n = 3; lower rectum, n = 4) within the level 3 layer and without lymph node involvement, with the diagnosis confirmed by preliminary endoscopy, endoscopic ultrasound and endoscopic biopsies. ESD using the CC was performed in all cases, and the therapeutic efficacy, safety and tumour recurrence were assessed. Results: All lesions were treated easily and safely, and there were no inadvertent incisions. En bloc resection was obtained in all cases, and histologic tumour-free lateral/basal margins were obtained in six of the seven patients. No delayed haemorrhage, perforation or tumour recurrence occurred. Conclusion: ESD using the CC appears to be an easy, safe and technically efficient method for resecting rectal carcinoid tumour.

DOI： 10.1111/ans.12643

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Although the involvement of helper T (Th) and regulatory T (Treg) cell-related immune molecules in pathogenesis of inflammatory bowel disease (IBD) is widely accepted, no discriminatory mucosal expression profiles of these molecules between ulcerative colitis (UC) and Crohn's disease (CD) have been clarified. Methods: Mucosal expression of 17 cytokines and transcription factors related to Th1, Th2, Th17, and Treg were measured by quantitative PCR in endoscopic biopsies from inflamed (40 from UC [UCI] and 20 from CD [CDI]) and noninflamed (47, 22, and 25 from UC, CD, and controls, respectively) colon or ileum. The discriminatory power of these markers to differentiate between the 2 diseases was evaluated by linear discriminant analysis and, unsupervised, principal component analysis. Results: By univariate analysis, many targets were markedly increased in inflamed versus noninflamed areas. However, marker expression was almost comparable between UCI and CDI, with the largest difference in UCI-predominant interleukin (IL) 21 and IL-13 with area under the receiver operating characteristic curve (AUC) values of 0.704 and 0.664, respectively. In contrast, combinations of 2 to 7 markers improved UCI versus CDI discrimination with AUC = 0.875 to 0.975. Among these, a 5-maker set (interferon-g, IL-12 p35, T-bet, GATA3, and IL-21) demonstrated an AUC of 0.949 and a misclassification rate of 8.3&#37;. Principal component analysis also markedly separated UCI and CDI. Conclusions: Inflamed mucosae from UC and CD could be discriminated with high accuracy using combinations of Th cell-related markers. Multigene analysis, possibly reflecting the underlying pathogenesis, is expected to be useful for diagnosis, monitoring and further defining distinctive characteristics in inflammatory bowel disease. Copyright © 2014 Crohn's & Colitis Foundation of America, Inc.

DOI： 10.1097/MIB.0000000000000028

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Aim: The etiology of post-inflammatory gastrointestinal (GI) motility dysfunction, after resolution of acute symptoms of inflammatory bowel diseases (IBD) and intestinal infection, is largely unknown, however, a possible involvement of T cells is suggested. Methods: Using the mouse model of T cell activation-induced enteritis, we investigated whether enhancement of smooth muscle cell (SMC) contraction by interleukin (IL)-17A is involved in postinflammatory GI hypermotility. Results: Activation of CD3 induces temporal enteritis with GI hypomotility in the midst of, and hypermotility after resolution of, intestinal inflammation. Prolonged upregulation of IL-17A was prominent and IL-17A injection directly enhanced GI transit and contractility of intestinal strips. Postinflammatory hypermotility was not observed in IL-17A-deficient mice. Incubation of a muscle strip and SMCs with IL-17A in vitro resulted in enhanced contractility with increased phosphorylation of Ser19 in myosin light chain 2 (p-MLC), a surrogate marker as well as a critical mechanistic factor of SMC contractility. Using primary cultured murine and human intestinal SMCs, IκBζ- and p38 mitogen-activated protein kinase (p38MAPK)-mediated downregulation of the regulator of G protein signaling 4 (RGS4), which suppresses muscarinic signaling of contraction by promoting inactivation/desensitization of Gαq/11 protein, has been suggested to be involved in IL-17A-induced hypercontractility. The opposite effect of L-1β was mediated by IκBζ and c-jun N-terminal kinase (JNK) activation. Conclusions: We propose and discuss the possible involvement of IL-17A and its downstream signaling cascade in SMCs in diarrheal hypermotility in various GI disorders. © 2014 Akiho et al.

DOI： 10.1371/journal.pone.0092960

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Endoscopic necrosectomy (EN) for walled-off pancreatic necrosis (WOPN) is less invasive than surgical treatment and has become the first choice for pancreatic abscess. EN is usually carried out with several devices including snares, baskets, and grasping forceps. Occasionally, we have encountered cases in which EN has not been satisfactorily carried out, and there is pressure for further innovation in EN. Here, we describe a case of a large area of WOPN that was successfully treated by EN with endoscopic submucosal dissection and associated techniques, which facilitated removal of necrotic tissues. A 60-year-old man was referred to our hospital for WOPN as a complication of necrotizing pancreatitis. As a result of his complicating conditions including ischemic heart disease, uncontrollable arrhythmia, chronic renalfailure, and persistent pleural effusion, he was deemed a poor surgical candidate. Although EN with conventional devices was carried out for five sessions, we could not remove the dense and massive necrotic tissues. At the sixth EN session, the Clutch Cutter device (Fujifilm, Tokyo, Japan) was used to remove the necrotic tissues, without major complications. This is believed to be the first report of EN using the Clutch Cutter for successful treatment of WOPN. © 2013 Japan Gastroenterological Endoscopy Society.

DOI： 10.1111/den.12134

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and study aims. Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis compared with other solid pancreatic tumors. Diagnosis of PDAC in the earliest possible stage is important to improve the prognosis. Although endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been the gold-standard modality for diagnosing pancreatic lesions, its diagnostic yield is not satisfactory for pancreatic tumors smaller than 20 mm. The purpose of this study was to determine the EUS findings that are useful for differentiating PDAC from other solid pancreatic tumors when the lesions are smaller than 20 mm. Patients and methods. We performed a retrospective review of 126 patients with pancreatic tumors smaller than 20 mm who had undergone EUS. According to the final pathological diagnoses, they were categorized into either the PDAC or non-PDAC group. We, then, compared the EUS findings between the two groups. Results. Among the 126 patients, we diagnosed PDAC in 75 patients and non-PDAC in the remaining patients, including neuroendocrine tumor in 43 patients, intraductal papillary mucinous carcinoma in 3 patients, solid pseudopapillary neoplasm in 2 patients, and inflammatory pseudotumor in 3 patients. Of all EUS findings, three factors were significantly indicative of PDAC: an irregular tumor edge, main pancreatic duct dilation, and tumor location in the pancreatic head. The predicted probability for PDAC was 80&#37;, 92.6&#37;, and 74.1&#37;, respectively. Conclusions. EUS could be a useful modality for differentiating PDAC from other solid pancreatic tumors, when the diagnostic yield of EUS-FNA is unsatisfactory, even for lesions smaller than 20 mm. © 2014 Informa Healthcare.

DOI： 10.3109/00365521.2013.878745

記述言語：日本語  

記述言語：日本語  

炎症性腸疾患(IBD)の発症に腸管での過度のT helper(Th)反応が関与している。Th反応はTh1、Th2、Th17からなり、正常の腸管では免疫反応を制御するregulatory T cellとの間でバランスが保たれている。IBD腸管ではその調節機構が破綻しており、クローン病ではTh1、Th17反応の亢進が、潰瘍性大腸炎ではTh17反応の亢進とIL-13発現上昇がみられる。IBD腸管のTh制御機構破綻のメカニズムを明確にすることは、治療のターゲットを明らかにし、新規治療法開発に重要である。IBDにおけるTh反応制御異常に関して最新の知見を含めて解説する。(著者抄録)

DOI： 10.11405/nisshoshi.110.1889

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background Double balloon endoscopy (DBE) allows the entire small intestine to be viewed using a combination of antegrade and retrograde approaches. Acute pancreatitis is a serious complication of antegrade DBE with no effective prophylactic treatment currently available. Ulinastatin has been shown to be effective for the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography. We therefore assessed the efficacy of ulinastatin for hyperenzymemia after antegrade DBE. Patients and methods Forty-four patients were enrolled in this prospective, randomized, double-blind, placebo-controlled trial. Patients in the ulinastatin group received 150 000 U ulinastatin by i.v. drip infusion for 2 h from the start of the procedure. Serum concentrations of pancreatic amylase and lipase were measured before and 3 and 18 h after antegrade DBE. Results The study was terminated after interim analysis. Of the 44 patients, 23 were randomized to ulinastatin and 21 to placebo.The groups were similar with regard to sex ratio, age, type of endoscope, insertion time, total procedure time, number of endoscope pull-back procedures, and baseline pancreaticamylase and lipase concentrations. Post-DBE hyperenzymemia was observed in 35.0&#37; and 47.8&#37; of patients in the placebo and ulinastatin groups, respectively. The higher frequency of hyperenzymemia in the ulinastatin group was unexpected, but the difference was not statistically significant. One patient in the placebo group (5.0&#37;) and none in the ulinastatin group experienced acute pancreatitis, but the difference was not statistically significant. Conclusion The results of this trial suggest that ulinastatin does not prevent hyperenzymemia following antegrade DBE. © 2012 The Authors.

DOI： 10.1111/den.12014

記述言語：その他   掲載種別：研究論文（学術雑誌）  

In February 2010, a 50-year-old man was admitted to a clinic complaining of back pain. Enhanced computed tomography (CT) images showed that there was a unilocular cyst, approximately 40 mm in size, in the pancreatic head of his abdomen. He was diagnosed as having a pancreatic pseudocyst caused by pancreatitis. After treatment, the patient's symptoms disappeared. However, in July 2010, he was referred to our medical center because back pain had reappeared along with obstructive jaundice. CT imaging showed growth of the cystic lesion and a low-density area of newly appeared cysts. The combination of clinical course and ¡results suggested malignancy, but it was difficult to confirm the diagnosis. Specimens sampled with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) revealed acinar cell carcinoma (ACC). This case showed atypical images for ACC as cystic lesions were dominant These results are notable in that ACC may reveal atypical findings and that EUS-FNA can be useful in the diagnosis of such cases.

記述言語：日本語  

症例は50歳の男性。背部痛を主訴に近医を受診した。腹部CTにて膵頭部に40mm大の不整な嚢胞性病変を認め、慢性膵炎の急性増悪、膵仮性嚢胞と診断され、保存的に症状が軽快した。5ヵ月後に皮膚黄染を認め、CTにて病変は75mmまで増大を認め、胆管圧迫に伴う閉塞性黄疸の診断にて当院に入院となった。内視鏡ドレナージ後も黄疸が遷延したため、減圧と組織学的評価を行うために超音波内視鏡下穿刺術(EUS-FNA)が施行され、膵腺房細胞癌(ACC)と診断された。自験例はACCとしては稀な画像所見を呈し、EUS-FNAによる病理学的評価が診断、治療方針決定に有用であった。(著者抄録)

記述言語：英語  

To evaluate the diagnostic yield of the procedure, mucosal-incision assisted biopsy (MIAB), for the histological diagnosis of gastric gastrointestinal stromal tumor (GIST), we performed a retrospective review of the 27 patients with suspected gastric GIST who underwent MIAB in our hospitals. Tissue samples obtained by MIAB were sufficient to make a histological diagnosis (diagnostic MIAB) in 23 out of the 27 patients, where the lesions had intraluminal growth patterns. Alternatively, the samples were insufficient (non-diagnostic MIAB) in remaining 4 patients, three of whom had gastric submucosal tumor with extraluminal growth patterns. Although endoscopic ultrasound and fine needle aspiration is the gold standard for obtaining tissue specimens for histological and cytological analysis of suspected gastric GISTs, MIAB can be used as an alternative method for obtaining biopsy specimens of lesions with an intraluminal growth pattern.

DOI： 10.4253/wjge.v5.i4.191

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Background and Aim: Endoscopic submucosal dissection (ESD) is now accepted as a minimally invasive treatment for early gastric cancer (EGC). To our knowledge, however, the functional effects of ESD have not been determined in patients with EGC. We therefore investigated whether gastric motility was affected by ESD. Methods: Using the 13C-octanoic acid breath test, gastric emptying of solid test meals was examined in 26 EGC patients and 18 healthy controls, with EGC patients assayed before and about 2 months after ESD. Based on 13CO2 breath-excretion curves, the lag-phase time (Tlag), half-emptying time (T1/2), and gastric emptying coefficient (GEC) were calculated as indices of gastric emptying. Results: In healthy controls, the mean Tlag, T1/2, and GEC were 85.5±4.9min, 148.5±8.0min, and 3.01±0.09h, respectively. Before ESD, the mean Tlag, T1/2, and GEC in the EGC patients were 90.1±5.5min, 174.7±10.4min, 2.64±0.08h, respectively. GEC, but not Tlag or T1/2, differed significantly in the two groups, with gastric emptying slower in EGC patients than in controls. Relative to before ESD, the mean Tlag, T1/2, and GEC in EGC patients after ESD were 109.2&#37;±7.8&#37;, 107.9&#37;±9.6&#37;, 108.4&#37;±4.7&#37;, respectively, indicating that ESD did not significantly affect any of these gastric emptying parameters in EGC patients. Conclusion: ESD is an effective treatment for EGC both in preserving organs and gastric motility. © 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

DOI： 10.1111/jgh.12086

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Gastric gastrointestinal stromal tumor smaller than 20 mm with liver metastasis
There have been no reports of gastric gastrointestinal stromal tumors (GISTs) <20 mm with distant metastasis. We report a case of a 15-mm gastric GIST with liver metastasis 1 year after surgical resection of the primary lesion. A 35-year-old man underwent routine esophagogastroduodenoscopy in July 2009. A submucosal tumor (SMT) <20 mm was incidentally detected at the posterior wall of the gastric body. Endoscopic ultrasound (EUS) indicated that it was a gastrointestinal mesenchymal tumor, including GIST, leiomyoma or schwannoma. He did not accept regular follow-up for this gastric SMT, therefore local laparoscopic excision was carried out in October 2009. The final pathological diagnosis after surgery was GIST, 15 mm in size, and a mitotic rate of 7/50 high-power fields, which did not indicate a high metastatic risk. The patient was followed up regularly without adjuvant chemotherapy. At 1 year after surgery, a space-occupying lesion ~15 mm was detected in the left lobe of the liver by abdominal ultrasound, where no mass lesion had been observed before surgery. To make a definite diagnosis of the hepatic mass lesion, EUS-guided fine-needle aspiration was performed, which demonstrated a metastatic liver tumor from a gastric GIST. Although this was a rare case, we should keep in mind that gastric GISTs do have a chance of malignant behavior, even if <20 mm. © 2013 Springer Japan.

DOI： 10.1007/s12328-012-0351-0

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: 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

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Aims Daikenchuto, a traditional Japanese herbal medicine, suppresses bacterial translocation by improvement of gastrointestinal motility and blood flow. As Daikenchuto reportedly reduces gastrointestinal inflammatory activity by these mechanisms, we analyzed whether Daikenchuto suppresses experimental colitis and reduces inflammatory cytokine expression in a mouse model. Methods Colitis was induced by transfer of naive CD4+ T cells of BALB/c mice into SCID mice, and mice were given either control or 2.7 &#37; Daikenchuto-containing feed. We investigated body weight, clinical symptoms, histological changes, and Th1- and Th17-cytokine expression. Cytokine mRNA expression was analyzed using real-time RT-PCR. The ratio of IL-17+ and IFN-c+ CD4+ T cells were analyzed by flow cytometry. Results Daikenchuto delayed the development of colitis and significantly reduced the histological inflammation scores. Analyses of cytokine mRNA revealed that Th17 cytokines were significantly decreased in colons of mice that received Daikenchuto. Absolute numbers of IL-17+ or IFN-c+ CD4+ T cells per colon were less in mice receiving Daikenchuto than in mice that received control feed, as both groups received naive CD4+ T cells to induce colitis. Conclusions We demonstrated that feeding administration of Daikenchuto suppresses colitis induced by naive CD4+ T cell transfer into SCID mice. Daikenchuto may show clinical benefit in the treatment of human inflammatory bowel disease and further studies are warranted. © 2012 Springer Science+Business Media, LLC.

DOI： 10.1007/s10620-012-2218-0

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Aims Although CD30 has long been recognized as an important marker in many lymphomas of diverse origin, and as an activation molecule on B and T cells, its primary function has remained obscure. Soluble CD30 (sCD30) is released from CD30 on the cell membrane by enzymatic cleavage. This study investigated the role of CD30 ligand (CD30L)/CD30 signals in intestinal mucosal damage. Methods Serum sCD30 in patients with ulcerative colitis (UC) and Crohn's disease (CD) and healthy individuals was assessed. A model of enteritis induced by anti-CD3 monoclonal antibody injection was studied in wild-type mice and in CD30L knockout mice. Results Increased sCD30 was observed in UC and CD patients, and the level was correlated with disease activity in both conditions. In a murine model of enteritis, histological intestinal damage was significantly reduced in CD30L knockout mice with decreased Th1 and Th17 cytokine levels. Moreover, blocking of CD30L/CD30 signals by CD30-immunoglobulin (CD30-Ig) resulted in reduced inflammation. Conclusions Increased sCD30 expression correlating with disease activity suggested that CD30L/CD30 signals play an important role in pathogenesis of UC and CD. CD30L/CD30 pathway acts as an accelerator of enteritis in a murine disease model. Successful blockade of enteritis by CD30-Ig suggests a potential tool for future therapy of inflammatory bowel diseases. © Springer Science+Business Media, LLC 2012.

DOI： 10.1007/s10620-012-2129-0

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A man in his fifties had a medical checkup. Mucosal papillomatosis in his oral cavity and palmoplantar keratosis were observed. Esophagogastroduodenoscopy revealed multiple polypoid lesions both in the esophagus and stomach. In addition, colonoscopy showed schwannoma in the rectum. He underwent an operation for adenomatous goiter. At first his typical esophageal multiple polypoid lesion was a diagnostic cue to Cowden disease (CD). Other clinical findings convinced us that he was suffering from CD. He was, then, diagnosed as CD according to the criteria of International Cowden Consortium although he had no family medical history suspicious of CD. Interestingly, genetic testing revealed that the patient had a germline mutation in exon5 of PTEN on chromosome 10. It was a point mutation of C to T transition at codon130, resulting in nonsense mutation (CGA→TGA). A close follow-up, especially cancer surveillance, is necessary for him since CD is associated with a high risk of developing malignant disease. It is noted that the typical esophageal features can be a diagnostic cue to CD, as shown in the present case.

DOI： 10.11405/nisshoshi.109.593

記述言語：日本語  

症例は67歳、男性。嚥下困難を主訴に来院した。食道下部に長径1cmの狭窄を認め、超音波内視鏡検査で全周性の粘膜肥厚を認めること、狭窄症状を幼少時より認めていることから先天性食道狭窄症と診断した。内視鏡的バルーン拡張術で治療を行ったところ著明な改善を認めた。先天性食道狭窄症は稀な疾患であり、多くは乳児期、幼児期に診断・治療されるが、成人となって診断される事もあり嚥下障害のある患者の鑑別疾患として認識する必要がある。(著者抄録)

記述言語：日本語  

症例は50歳代男性。病歴は、2009年Cowden病を疑われ当科紹介受診。歯肉の結節状乳頭腫、手掌に角化性丘疹、食道に多発小隆起、直腸神経鞘腫、腺腫様甲状腺腫を認め、Cowden病の診断に至った。PTEN遺伝子exon5 codon130に変異(CGA→TGA)を認めた。Cowden病は悪性腫瘍を合併する頻度が高いため、慎重な経過観察が必要である。(著者抄録)

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Background: To provide rapid immunosuppression without side effects, we analyzed whether rapamycin alone, and regulatory T cells (Tregs) expanded ex vivo by rapamycin, suppressed colitis in a mouse model. Methods: Severe combined immunodeficiency (SCID) mice reconstituted with naive CD4+ T cells were treated with or without intraperitoneal rapamycin. Body weight was evaluated. CD4+ T cells were cultured inthe presence of rapamycin for three 7-day rounds of stimulation. The ratio of Tregs to CD4+T cells was analyzed by flow cytometry. NaiveCD4+T cells were transferred into SCID mice with CD4+ T cells expanded in the presence or absence of rapamycin. Clinical symptoms of colitis, histological changes, and cytokine expression were investigated. Results: Systemic rapamycin partially prevented the development of colonic inflammation in a transfer model of colitis, but decreased body weight in control mice. With rapamycin, stimulated CD4 +T cells expanded eightfold in 3 weeks in vitro, and the proportion of Tregs increased to about 40&#37;. Without rapamycin, CD4+T cells expanded 20-fold in 3 weeks, but the proportion of Tregs remained at about 15&#37;. CD4+ T cells expanded with rapamycin prevented the development of colitis in a naïve CD4+ T-cell transfer model, in association with the down regulation of Th1 and Th17 responses. Conclusions: We demonstrated, for the first time, that CD4+ T cells expanded with rapamycin in vitro suppressed colitis. Therefore, rapamycin-expanded Treg transfer therapy is expected to be efficacious for inflammatory bowel disease. © Springer 2012.

DOI： 10.1007/s00535-011-0502-y

記述言語：英語  

Endoscopic submucosal dissection (ESD) is now the most common endoscopic treatment in Japan for intramucosal gastrointestinal neoplasms (non-metastatic). ESD is an invasive endoscopic surgical procedure, requiring extensive knowledge, skill, and specialized equipment. ESD starts with evaluation of the lesion, as accurate assessment of the depth and margin of the lesion is essential. The devices and strategies used in ESD vary, depending on the nature of the lesion. Prior to the procedure, the operator must be knowledgeable about the treatment strategy(ies), the device(s) to use, the electrocautery machine settings, the substances to inject, and other aspects. In addition, the operator must be able to manage complications, should they arise, including immediate recognition of the complication(s) and its treatment. Finally, in case the ESD treatment is not successful, the operator should be prepared to apply alternative treatments. Thus, adequate knowledge and training are essential to successfully perform ESD.

DOI： 10.4253/wjge.v4.i4.123

記述言語：英語  

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. © 2011 Springer.

DOI： 10.1007/s12328-011-0282-1

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Background Colonic smooth muscle contractility is altered in colitis, and several protein kinase pathways can mediate colonic smooth muscle contraction. In the present study, we investigated whether protein kinase C (PKC) pathways also play a role in colonic hypercontractility observed during T H2 colitis in BALB/c mice. Methods Colitis was induced in BALB/c mice by provision of 5&#37; dextran sodium sulfate (DSS) for 7days. Changes in smooth muscle contractility were examined using dissected circular smooth muscle preparations from the distal colon. The contribution of conventional and novel PKC isozymes to the hypercontractile response was examined with pharmacological PKC inhibitors. Western blot analyses were used to examine protein expression and phosphorylation changes. Key Results Colonic smooth muscle was associated with inflammation-induced hypercontractility and altered PKC expression. Carbachol-induced peak (phasic) and sustained (tonic) contractions were increased. Chelerythrine was the most effective PKC inhibitor of both phasic and tonic contractions. There was no general difference in the percent contribution of conventional and novel PKC isozymes toward the DSS-induced hypercontractility, but inhibition of sustained force with GF109203x was higher for inflamed muscle. The CPI-17 phosphorylation was equally suppressed in both normal and DSS conditions by Gö6976 and chelerythrine, but only for the phasic component of contraction. Conclusions & Inferences The outcomes suggest that both conventional and novel PKC isozymes contribute to the phasic and tonic contractile components of BALB/c colonic circular smooth muscle under normal conditions, with novel PKC isozymes having a greater contribution to the tonic contraction. However, no effect of inflammation was observed on the relative contribution of PKC and CPI-17 toward the observed hypercontractility. © 2011 Blackwell Publishing Ltd.

DOI： 10.1111/j.1365-2982.2011.01821.x

記述言語：英語  

Background Treatment with infliximab, a chimeric antitumor necrosis factor (TNF)-α antibody, is highly efficient in patients with inflammatory bowel disease (IBD). It neutralizes soluble TNF-α and induces the apoptosis of transmembrane TNF-α-positive macrophages and T cells in the gut. Recently, T helper (Th)17, as well as Th1, responses have been implicated in the pathogenesis of IBD. Aims To clarify the effects of infliximab on Th1 and Th17 responses in vitro. Methods Naive CD4 + T cells isolated from the peripheral blood of healthy volunteers were stimulated under Th1- or Th17-inducing conditions in the presence of 10 μg/ml of infliximab or control immunoglobulin (Ig)G1. The concentrations of interferon (IFN)-c, interleukin (IL)-17, and TNF-α in the culture supernatants were determined by enzyme-linked immunosorbent assay (ELISA). Th1 and Th17 cells were immunostained with infliximab or control IgG1 and transmembrane TNF-α-positive cells were analyzed by flow cytometry. Annexin V staining and terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL) assays were conducted in order to analyze the percentage of apoptotic cells. Results Both Th1 and Th17 cells expressed soluble and transmembrane TNF-α abundantly. Although infliximab suppressed IFN-γ secretion by Th1 cells and IL-17 secretion by Th17 cells, the level of the former was more profound than the latter. Infliximab increased annexin V- and TUNEL-positive apoptotic cells under Th1-inducing conditions, but not under Th17-inducing conditions. Conclusions Infliximab suppressed Th1 and Th17 differentiation in vitro; however, IFN-γ production by Th1 cells was more profoundly suppressed than IL-17 secretion by Th17 cells. Th1 responses were more susceptible to infliximab-mediated apoptosis than Th17 responses. Our results clarify a new mechanism of action of infliximab. © Springer Science+Business Media, LLC 2011.

DOI： 10.1007/s10620-011-1780-1

記述言語：英語  

Inflammation and immune activation in the gut are usually accompanied by alteration of gastrointestinal (GI) motility. In infection, changes in motor function have been linked to host defense by enhancing the expulsion of the infectious agents. In this review, we describe the evidence for inflammation and immune activation in GI infection, inflammatory bowel disease, ileus, achalasia, eosinophilic esophagitis, microscopic colitis, celiac disease, pseudo-obstruction and functional GI disorders. We also describe the possible mechanisms by which inflammation and immune activation in the gut affect GI motility. GI motility disorder is a broad spectrum disturbance of GI physiology. Although several systems including central nerves, enteric nerves, interstitial cells of Cajal and smooth muscles contribute to a coordinated regulation of GI motility, smooth muscle probably plays the most important role. Thus, we focus on the relationship between activation of cytokines induced by adaptive immune response and alteration of GI smooth muscle contractility. Accumulated evidence has shown that Th1 and Th2 cytokines cause hypocontractility and hypercontractility of inflamed intestinal smooth muscle. Th1 cytokines downregulate CPI-17 and L-type Ca(2+) channels and upregulate regulators of G protein signaling 4, which contributes to hypocontractility of inflamed intestinal smooth muscle. Conversely, Th2 cytokines cause hypercontractilty via signal transducer and activator of transcription 6 or mitogen-activated protein kinase signaling pathways. Th1 and Th2 cytokines have opposing effects on intestinal smooth muscle contraction via 5-hydroxytryptamine signaling. Understanding the immunological basis of altered GI motor function could lead to new therapeutic strategies for GI functional and inflammatory disorders.

記述言語：日本語  

Brunner腺由来の腺腫・癌はともにまれな疾患である.Brunner腺腫は,無茎～亜有茎性の粘膜下腫瘍様の病変として認められ,一部には中心陥凹を伴うことがある.超音波内視鏡検査(EUS)では,第3層に連続した均一な等～低エコーレベルの充実性腫瘍として描出される.病理組織学的所見では,Brunner腺由来と考えられるが,正常Brunner腺と明らかに異なる組織異型を示す.またBrunner腺由来の十二指腸癌は,他の十二指腸癌と比べ,陥凹を伴う粘膜下腫瘍様の形態をとり,EUSでは第3層に等～高エコーな病変として描出され,腫瘍内には<gaj code="56CA" kind="unicode">のう</gaj>胞と考えられる低エコーな部分を認めることが多い.(著者抄録)

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 44-year-old female was referred to our hospital with a complaint of abdominal fullness. Computed tomography (CT) showed multiple liver masses and a huge ovarian tumor. Colonoscopy revealed a type 4 advanced cancer in the sigmoid colon. She was diagnosed with unresectable liver and ovarian metastases from advanced sigmoid colon cancer, for which we were obliged to select chemotherapy. As the first line, FOLFOX was applied and performed for 6 cycles, followed by FOLFOX plus bevacizumab (BV) for 5 cycles. While no deterioration of liver and ovarian metastases was observed during the course of those chemotherapy regimens, the patient developed a considerable level of acute sensorimotor neuropathic symptoms associated with oxaliplatin-induced peripheral neurotoxicity, forcing us to replace FOLFOX plus BV with FOLFIRI plus BV. Three cycles of FOLFIRI plus BV, however, turned out to be progressive disease with deterioration of liver and ovarian metastases. Since her oxaliplatin-induced neurotoxicity was improved, a regimen of FOLFOX plus BV was once again applied to her for 3 cycles, which failed to prevent her from having a progressive disease. The sequencing of K-RAS genes from the biopsy specimens of sigmoid colon cancer revealed an expression of a wild-type K-RAS. Thus, an addition of panitumumab to FOLFOX was made. Surprisingly, after 3 cycles of the chemotherapy regimen over 3 months, a significant reduction in the size of liver and ovarian metastases was observed. Her sense of abdominal fullness was apparently reduced and was even lower than what it was at admission. Panitumumab has great potential for effective treatment of patients with unresectable stage IV colorectal cancer, even after having acquired resistance to prior chemotherapy regimens.

記述言語：日本語  

症例は44歳、女性。腹部膨満感、腹痛、食思不振を主訴に近医を受診。腹部造影CT検査にて多発肝腫瘤、巨大卵巣腫瘤を指摘され当院を紹介受診し、精査の結果S状結腸癌多発肝転移・卵巣転移と診断した。FOLFOX療法を6サイクル施行後、bevacizumab(BV)を追加し、さらに5サイクル施行。SDが得られていたが、oxaliplatinによる末梢神経障害のため、BV/FOLFIRI療法に変更した。3サイクル後の評価にてPDと判定。その間に末梢神経障害が改善したため、再度BV/FOLFOX療法を3サイクル施行したがPDであった。K-RAS野生型であったため、panitumumabを導入(+FOLFOX療法)したところ、肝転移・卵巣転移とも著明に縮小し、QOL阻害の原因であった腹部膨満感も著明に改善した。(著者抄録)

記述言語：その他   掲載種別：研究論文（学術雑誌）  

A 63-year-old woman was referred to our hospital for further examination of a rectal submucosal tumor (SMT), which had been discovered by her family doctor. Colonoscopy revealed a solid tumor of 10 mm in diameter covered with normal mucosa at the Rb region of the rectum, indicating it was an SMT such as GIST or leiomyoma. In order to make a final diagnosis of the exact type of SMT, some portion of the SMT was exposed by incising the mucosa covering the lesion, which was followed by a direct vision biopsy using conventional biopsy forceps. The quality and quantity of the biopsy specimen was good enough for pathologists to make a final diagnosis of GIST. A surgical procedure was subsequently carried out. Primary rectal GIST is considered to have a relatively worse prognosis compared to GIST observed in other area of the gastrointestinal tract. It is also very hard to complete a surgical procedure without affecting defecation function when GIST is advanced. It would be, therefore, very important to diagnose a rectal GIST as early as possible. We therefore propose that direct vision biopsy with an incision of the mucosa covering an SMT can be a very useful technique to make an early diagnosis of rectal GIST.

記述言語：日本語  

63歳女性。患者は便秘の精査目的で受診、大腸内視鏡検査にて直腸Rbに径10mm大の粘膜下腫瘍が認められたが、生検による病理組織学的診断には至らなかった。そこで、内視鏡的に粘膜切開して腫瘍を露出させた上で直視下生検を施行したところ、病理組織学的所見では紡錘形細胞が束状索状に密に増殖しており、免疫染色ではCD34(+)、kit(+)、S-100(-)、desmin(-)であった。以上より、本症例はGISTと診断され、核分裂像では低悪性度が予想されたため経肛門的直腸腫瘍切除術が施行された。その結果、術後経過は良好で約2週間で退院となり、目下、半年経過で再発は認められていない。

記述言語：英語  

The number of patients suffering from symptoms associated with gastrointestinal (GI) motility disorders is on the rise. GI motility disorders are accompanied by alteration of gastrointestinal smooth muscle functions. Currently available drugs, which can directly affect gastrointestinal smooth muscle and restore altered smooth muscle contractility to normal, are not satisfactory for treating patients with GI motility disorders. We have recently shown that ERK1/2 and p38MAPK signaling pathways play an important role in the contractile response not only of normal intestinal smooth muscle but also of inflamed intestinal smooth muscle. Here we discuss the possibility that ERK1/2 and p38MAPK signaling pathways represent ideal targets for generation of novel therapeutics for patients with GI motility disorders.

DOI： 10.4291/wjgp.v2.i2.19

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: After the recent discovery of Th17 cells, it was proposed that Th17 responses are involved in the pathogenesis of inflammatory bowel diseases (IBD). CD4+CD25+ regulatory T cells (Treg) are considered to be an attractive tool for the treatment of IBD. Here, we investigated whether Treg are capable of suppressing Th17-mediated colitis. Methods: Naive CD4 + T cells were transferred into SCID mice with or without Treg. In some experiments, Treg were transferred into recipient mice with established colitis. Mice treated with Treg were injected with an anti-transforming growth factor (TGF)-β mAb or control IgG. Clinical symptoms of colitis, histological changes and cytokine expressions were investigated. Results: SCID mice transferred with naive CD4+ T cells developed chronic colitis with significant increases in Th1 and Th17 cytokine expressions in the colon. When Treg were co-transferred with naive CD4+ T cells, development of colitis was prevented, and Th17 cytokine expressions were markedly reduced. Similarly, when Treg were transferred into mice with established colitis, the colitis was significantly ameliorated in association with dramatic reductions in Th17 cytokine expressions. Injection of anti-TGF-β mAb abolished the Treg-mediated suppression with significant elevations in Th17 cytokine productions. Conclusion: This adoptive transfer model of colitis was associated with augmented Th1 and Th17 responses, and Treg were capable of suppressing colonic inflammation by downregulating Th17 responses as well as Th1 responses via TGF-β. Consequently, Treg transfer therapy is expected to be efficacious for IBD even if Th17 is involved in the pathogenesis. © 2010 Springer Science+Business Media, LLC.

DOI： 10.1007/s10620-010-1286-2

記述言語：英語  

The pathogenesis of irritable bowel syndrome (IBS) is considered to be multifactorial and includes psychosocial factors, visceral hypersensitivity, infection, microbiota and immune activation. It is becoming increasingly clear that low-grade inflammation is present in IBS patients and a number of biomarkers have emerged. This review describes the evidence for low-grade inflammation in IBS and explores its mechanism with particular focus on gastrointestinal motor dysfunction. Understanding of the immunological basis of the altered gastrointestinal motor function in IBS may lead to new therapeutic strategies for IBS.

DOI： 10.4291/wjgp.v1.i3.97

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: Clostridium difficile is the leading cause of nosocomial infectious diarrhea. Antibiotic resistance and increased virulence of strains have increased the number of C difficile-related deaths worldwide. The innate host response mechanisms to C difficile are not resolved; we propose that hypoxia-inducible factor (HIF-1) has an innate, protective role in C difficile colitis. We studied the impact of C difficile toxins on the regulation of HIF-1 and evaluated the role of HIF-1α in C difficile-mediated injury/inflammation. Methods: We assessed HIF-1α mRNA and protein levels and DNA binding in human mucosal biopsy samples and Caco-2 cells following exposure to C difficile toxins. We used the mouse ileal loop model of C difficile toxin-induced intestinal injury. Mice with targeted deletion of HIF-1α in the intestinal epithelium were used to assess the effects of HIF-1α signaling in response to C difficile toxin. Results: Mucosal biopsy specimens and Caco-2 cells exposed to C difficile toxin had a significant increase in HIF-1α transcription and protein levels. Toxin-induced DNA binding was also observed in Caco-2 cells. Toxin-induced HIF-1α accumulation was attenuated by nitric oxide synthase inhibitors. In vivo deletion of intestinal epithelial HIF-1α resulted in more severe, toxin-induced intestinal injury and inflammation. In contrast, stabilization of HIF-1α with dimethyloxallyl glycine attenuated toxin-induced injury and inflammation. This was associated with induction of HIF-1-regulated protective factors (such as vascular endothelial growth factor-α, CD73, and intestinal trefoil factor) and down-regulation of proinflammatory molecules such as tumor necrosis factor and Cxcl1. Conclusions: HIF-1α protects the intestinal mucosa from C difficile toxins. The innate protective actions of HIF-1α in response to C difficile toxins be developed as therapeutics for C difficile-associated disease. © 2010 AGA Institute.

DOI： 10.1053/j.gastro.2010.03.045

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Intestinal mucosal integrity is dependent on epithelial function and a regulated immune response to injury. Fucosyltransferase VII (Fuc-TVII) is an essential enzyme required for the expression of the functional ligand for E- and P-selectin. Trefoil factor 3 (TFF3) is involved in both protecting the intestinal epithelium against injury as well as aiding in wound repair following injury. The aim of the present study was to assess the interplay between barrier function and leukocyte recruitment in intestinal inflammation. More specifically, we aimed to examine how targeted disruption of Fuc-TVII either in wild-type or TFF3-/- mice would alter their susceptibility to colonic injury. TFF3 and Fuc-TVII double-knockout mice (TFF3/Fuc-TVII-/- mice) were generated by mating TFF3-/- and Fuc-TVII-/- mice. Colitis was induced by administration of dextran sodium sulfate (DSS) (2.5&#37; wt/vol) in the drinking water. Changes in baseline body weight, diarrhea, and fecal blood were assessed daily. Upon euthanasia, extents of colonic inflammation were assessed macroscopically, microscopically, and through quantification of myeloperoxidase (MPO) activity. Colonic lymphocyte subpopulations were assessed at 6 days after administration of DSS by flow cytometry and immunohistochemistry. No baseline intestinal inflammation was found in TFF3/Fuc-TVII-/-, TFF3-/-, Fuc-TVII -/-, or wild-type mice. Loss of Fuc-TVII resulted in a reduction in disease severity whereas TFF3-/- mice were markedly more susceptible to DSS-induced colitis. Remarkably, the loss of Fuc-TVII in TFF3-/- mice markedly decreased the severity of DSS-induced colitis as evidenced by reduced weight loss, diarrhea, decreased colonic MPO levels and improved survival. Furthermore, the loss of TFF3 resulted in increased severity of spontaneous colitis in IL-2/β-microglobulin-deficient mice. These studies highlight the importance of the interplay between factors involved in the innate immune response, mucosal barrier function, and genes involved in regulating leukocyte recruitment and other aspects of the immune response. Copyright © 2010 the American Physiological Society.

DOI： 10.1152/ajpgi.00228.2009

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Background/Aims: Proton pump inhibitor (PPI) therapy is considered as the first choice for treatment of non-erosive reflux disease (NERD). However, NERD is less sensitive to PPIs than erosive gastroesophageal reflux disease (GERD) and the differences between PPIs and H2 receptor antagonists are less evident in NERD than in erosive GERD. Since gastric acid secretion is lower in the Japanese population than in Western populations, we aimed to investigate whether PPI therapy is really necessary for NERD patients in Japan. Methodology: Thirty-three symptomatic endoscopically diagnosed NERD patients were randomly assigned to receive roxatidine acetate 75 mg twice daily (n=16) or omeprazole 20 mg once daily (n=17). Gastrointestinal symptoms were assessed using the Gastrointestinal Symptom Rating Scale at baseline and after 4 and 8 weeks of treatment. Results: Both roxatidine and omeprazole significantly improved the heartburn score at 4 and 8 weeks. The clinical response rates did not differ between roxatidine and omeprazole. Both roxatidine and omeprazole significantly relieved not only reflux but also abdominal pain and indigestion. The degrees of improvement did not differ between the two groups. Conclusion: Roxatidine relieved the symptoms of NERD patients with similar effectiveness to omeprazole. Therefore, roxatidine may be a good choice for NERD treatment. © H.G.E. Update Medical Publishing S.A.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

As a regulator of smooth muscle contraction, zipper-interacting protein kinase (ZIPK) can directly phosphorylate the myosin regulatory light chains (LC20) and produce contractile force. Synthetic peptides (SM-1 and AV25) derived from the autoinhibitory region of smooth muscle myosin light chain kinase can inhibit ZIPK activity in vitro. Paradoxically, treatment of Tritonskinned ileal smooth muscle strips with AV25, but not SM-1, potentiated Ca2+-independent, microcystin- and ZIPK-induced contractions. The AV25-induced potentiation was limited to ileal and colonic smooth muscles and was not observed in rat caudal artery. Thus the potentiation of Ca 2+-independent contractions by AV25 appeared to be mediated by a mechanism unique to intestinal smooth muscle. AV25 treatment elicited increased phosphorylation of LC20 (both Ser-19 and Thr-18) and myosin phosphatase-targeting subunit (MYPT1, inhibitory Thr-697 site), suggesting involvement of a Ca2+-independent LC20 kinase with coincident inhibition of myosin phosphatase. The phosphorylation of the inhibitor of myosin phosphatase, CPI-17, was not affected. The AV25-induced potentiation was abolished by pretreatment with staurosporine, a broad-specificity kinase inhibitor, but specific inhibitors of Rho-associated kinase, PKC, and MAPK pathways had no effect. When a dominant-negative ZIPK [kinase-dead ZIPK(1-320)-D161A] was added to skinned ileal smooth muscle, the potentiation of microcystin-induced contraction by AV25 was blocked. Furthermore, pretreatment of skinned ileal muscle with SM-1 abolished AV25-induced potentiation. We conclude, therefore, that, even though AV25 is an in vitro inhibitor of ZIPK, activation of the ZIPK pathway occurs following application of AV25 to permeabilized ileal smooth muscle. Finally, we propose a mechanism whereby conformational changes in the pseudosubstrate region of ZIPK permit augmentation of ZIPK activity toward LC20 and MYPT1 in situ. AV25 or molecules based on its structure could be used in therapeutic situations to induce contractility in diseases of the gastrointestinal tract associated with hypomotility. Copyright © 2009 the American Physiological Society.

DOI： 10.1152/ajpgi.00112.2009

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Inflammatory bowel disease (IBD) is associated with intestinal smooth muscle dysfunction. Many smooth muscle contractile events are associated with alterations in Ca2+-sensitizing pathways. The aim of the present study was to assess the effect of colitis on Ca2+ sensitization and the signaling pathways responsible for contractile dysfunction in murine experimental colitis. Colitis was induced in BALB/c mice by providing 5&#37; dextran sulfate sodium (DSS) in drinking water for 7 days. Contractile responses of colonic circular smooth muscle strips to 118 mM K+ and carbachol (CCh) were assessed. DSS induced a TH2 colitis [increased interleukin (IL)-4 and IL-6] with no changes in TH1 cytokines. Animals exposed to DSS had increased CCh-induced contraction (3.5-fold) and CCh-induced Ca 2+-sensitization (2.2-fold) responses in intact and α-toxin permeabilized colonic smooth muscle, respectively. The contributions of extracellular signal-regulated kinase (ERK) and p38 mitogen-activated protein kinase (MAPK) to CCh-induced contractions were significantly increased during colitis. Ca2+-independent contraction induced by microcystin was potentiated (1.5-fold) in mice with colitis. ERK and p38MAPK (but not Rho-associated kinase) contributed to this potentiation. ERK1/2 and p38MAPK expression were increased in the muscularis propria of colonic tissue from both DSS-treated mice and patients with IBD (ulcerative colitis ≫ Crohn's disease). Murine TH2 colitis resulted in colonic smooth muscle hypercontractility with increased Ca2+ sensitization. Both ERK and p38MAPK pathways contributed to this contractile dysfunction, and expression of these molecules was altered in patients with IBD. Copyright © 2009 The American Society for Pharmacology and Experimental Therapeutics.

DOI： 10.1124/mol.108.049858

記述言語：日本語  

症例は38歳女性。下腹部痛にて受診し、CTで回盲部の肥厚、少量の腹水、腸間膜リンパ節の腫大を認めた。大腸内視鏡は回盲弁の著明な肥厚のため小腸側へ通過不能で、小腸透視では回腸終末に全周性の狭窄がみられ、腹腔鏡補助下回盲部切除術を施行した。術中、回盲部漿膜を中心に多数の赤色小結節がみられた。病理診断は回腸結核、腸間膜リンパ節炎の所見で、赤色小結節は出血をともなう巨細胞性肉芽腫であった。(著者抄録)

記述言語：英語   掲載種別：研究論文（学術雑誌）  

We investigated the protein kinases responsible for myosin regulatory light chain (LC20) phosphorylation and regulation of myosin light chain phosphatase (MLCP) activity during microcystin (phosphatase inhibitor)-induced contraction at low Ca2+ concentrations of rat ileal smooth muscle stretched in the longitudinal axis. Application of 1 μM microcystin induced LC20 diphosphorylation and contraction of β-escin-permeabilized rat ileal smooth muscle at pCa 9. The PKC inhibitor GF-109203x, the MEK inhibitor PD-98059, and the p38 MAPK inhibitor SB-203580 significantly reduced this contraction. These inhibitory effects were abolished when the microcystin concentration was increased to 10 μM, indicating that application of these kinase inhibitors generated an increase in MLCP activity. GF-109203x and PD-98059, but not SB-203580, significantly decreased the phosphorylation level of the myosin-targeting subunit of MLCP, MYPT1, at Thr-697 (rat sequence) during microcystin-induced contraction at pCa 9. On the other hand, SB-203580, but not GF-109203x or PD-98059, significantly reduced the phosphorylation level of the PKC-potentiated phosphatase inhibitor of 17 kDa (CPI-17). A zipper-interacting protein kinase (ZIPK) inhibitor (SM1 peptide) and a Rho-associated kinase inhibitor (Y-27632) had little effect on microcystin-induced contraction at pCa 9. In conclusion, PKC, ERK1/2, and p38 MAPK pathways facilitate microcystin-induced contraction at low Ca2+ concentrations by contributing to the inhibition of MLCP activity either through phosphorylation of MYPT1 or CPI-17 [probably mediated by integrin-linked kinase (ILK)]. ILK and not ZIPK is likely to be the protein kinase responsible for LC20 diphosphorylation during microcystin-induced contraction of rat ileal smooth muscle at pCa 9, similar to its recently described role in vascular smooth muscle. The negative regulation of MLCP by PKC and MAPKs during microcystin-induced contraction at pCa 9, which is not observed in vascular smooth muscle, may be unique to phasic smooth muscle. Copyright © 2007 the American Physiological Society.

DOI： 10.1152/ajpgi.00214.2007

記述言語：英語   掲載種別：研究論文（学術雑誌）  

As a regulator of smooth muscle contractility, zipper-interacting protein kinase (ZIPK) appears to phosphorylate the regulatory myosin light chain (RLC20), directly or indirectly, at Ser19 and Thr18 in a Ca2+- independent manner. The calmodulin-binding and autoinhibitory domain of myosin light chain kinase (MLCK) shares similarity to a sequence found in ZIPK. This similarity in sequence prompted an investigation of the SM1 peptide, which is derived from the autoinhibitory region of MLCK, as a potential inhibitor of ZIPK. In vitro studies showed that SM1 is a competitive inhibitor of a constitutively active 32-kDa form of ZIPK with an apparent Ki value of 3.4 μM. Experiments confirmed that the SM1 peptide is also active against full-length ZIPK. In addition, ZIPK autophosphorylation was reduced by SM1. ZIPK activity is independent of calmodulin; however, calmodulin suppressed the in vitro inhibitory potential of SM1, likely as a result of nonspecific binding of the peptide to calmodulin. Treatment of ileal smooth muscle with exogenous ZIPK was accompanied by an increase in RLC20 diphosphorylation, distinguishing between ZIPK [and integrin-linked kinase (ILK)] and MLCK actions. Administration of SM1 suppressed steady-state muscle tension developed by the addition of exogenous ZIPK to Triton-skinned rat ileal muscle strips with or without calmodulin depletion by trifluoperazine. The decrease in contractile force was associated with decreases in both RLC20 mono- and diphosphorylation. In summary, we present the SM1 peptide as a novel inhibitor of ZIPK. We also conclude that the SM1 peptide, which has no effect on ILK, can be used to distinguish between ZIPK and ILK effects in smooth muscle tissues. Copyright © 2007 the American Physiological Society.

DOI： 10.1152/ajpcell.00434.2006

記述言語：英語  

Smooth muscle contractility is mainly regulated by phosphorylation of the 20 kDa myosin light chains (LC20), a process that is controlled by the opposing activities of myosin light chain kinase (MLCK) and myosin light chain phosphatase (MLCP). Recently, intensive research has revealed that various protein kinase networks including Rho-kinase, integrin-linked kinase, zipper-interacting protein kinase (ZIPK), and protein kinase C (PKC) are involved in the regulation of LC20 phosphorylation and have important roles in modulating smooth muscle contractile responses to Ca2+ (i.e., Ca2+ sensitization and Ca2+ desensitization). Here, we review the general background and structure of ZIPK and summarize our current understanding of its involvement in a number of cell processes including cell death (apoptosis), cell motility, and smooth muscle contraction. ZIPK has been found to induce the diphosphorylation of LC20 at Ser-19 and Thr-18 in a Ca2+-independent manner and to regulate MLCP activity directly through its phosphorylation of the myosin-targeting subunit of MLCP or indirectly through its phosphorylation of the PKC-potentiated inhibitory protein of MLCP. Future investigations of ZIPK function in smooth muscle will undoubtably focus on determining the mechanisms that regulate its cellular activity, including the identification of upstream signaling pathways, the characterization of autoinhibitory domains and regulatory phosphorylation sites, and the development of specific inhibitor compounds. © 2007 NRC.

DOI： 10.1139/Y06-103

記述言語：日本語  

1999年2月～2004年1月に咽喉頭異常感を主訴とし逆流性食道炎と診断された257名に,プロトンポンプ阻害剤を投与した.投与中止後に再発を認めた14名を対象に,年齢,性別,再発までの期間を検討した.再発を繰り返した2名については,長期的にランソプラゾールを投与し効果を判定した.14例のうち,男性は10例で平均52歳,再発までの平均期間は6ヵ月,女性は4例で平均57歳,再発までの平均期間は6ヵ月であり,平均年齢と再発までの期間に男女差はなかった.難治性の逆流性食道炎に対してはプロトンポンプ阻害剤の長期療法が有効であり,著者等は以下に提示する新しい治療法を提唱する.初期治療ではランソプラゾール30mg/dayで8週間投与し経過をみる.再発を認めたらランソプラゾール15mg/dayで投与し症状が消失するまで投与する.投与中に症状の悪化を認めたらランソプラゾールを30mg/dayに増量する,初期治療から1年後に上部消化管の内視鏡を行い効果を判定する.逆流性食道炎を認めたらランソプラゾール15mg/dayを投与し症状が消失するまで続ける

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The sequence requirement for N-terminal cleavage and the proteasomal degradation of p27Kip1 and their relationship was investigated. Residues 5-8 were required for the cleavage and the mutation of S10 to E inhibited the cleavage. The C-terminal PEST sequence was necessary for the degradation and residue R165 was found to play an important role in the degradation. The inhibition of the cleavage by deleting residues 5-8 inhibited the degradation, while the fragment mimicking the cleavage product accelerated the degradation. Both the cleavage and degradation demonstrated a similar sensitivity toward proteasome inhibitors and ATP depletion. These two processes are thus suggested to be tightly linked and sequential. © 2004 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

DOI： 10.1016/j.febslet.2004.08.014

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1067/S0016-5107(03)01876-5

記述言語：日本語  

47歳男.17歳時に皮膚血管腫を認め,37歳頃から頻回な鼻出血及び口腔内出血が出現し,40歳時には胃の毛細血管拡張病変を指摘されていた.慢性副鼻腔炎に対する治療目的で入院し,術前検査で貧血を認めたため,上部消化管内視鏡検査を施行した結果,胃及び十二指腸に多発する毛細血管拡張病変が認められた.父親にも皮膚血管腫及び頻回な鼻出血歴があることから,遺伝性出血性毛細血管拡張症(Osler病)と診断した.胃病変を貧血の原因と考え,アルゴンプラズマ凝固法(APC法)を施行し,2日間で約100ヶ所の病変を焼灼した.術後,病変は消失,潰瘍瘢痕化し,現在まで消化管出血を認めず,経過は良好である

記述言語：英語   掲載種別：研究論文（学術雑誌）  

We previously reported synergistic induction of apoptosis by IFN-γ plus either cyclosporin A (CsA) or tacrolimus (FK506) in gastric carcinoma cells. In this study, we aimed to elucidate the mechanism for this synergistic induction of apoptosis. IFN-γ plus CsA synergistically induced caspase-3 mediated apoptosis in gastric carcinoma cells. Although IFN-γ induced activation of signal transducer and activator of transcription1 (STAT1) and expression of interferon regulatory factor-1 (IRF-1) mRNA, IFN-γ alone was not able to induce caspase-3 activation and apoptosis. When gastric carcinoma cells were treated with cyclohexamide, a protein synthesis inhibitor, following IFN-γ pretreatment, caspase-3 was activated, and apoptosis was markedly induced. These findings suggest the existence of IFN-γ-induced anti-apoptotic pathway and we evaluated the effect of IFN-γ and CsA on calcium-sensitive nuclear factor-κB (NF-κB) activation. IFN-γ increased intracellular calcium ion concentration ([Ca2+]i) consisting of a spike and a sustained phase, and the latter was completely abrogated by CsA. Activation of NF-κB occurred in response to IFN-γ, and which was markedly inhibited by either CsA or FK506. NF-κB decoy also enhanced the cytotoxic effect of IFN-γ. These results suggest that IFN-γ may simultaneously induce the STAT1-mediated apoptotic pathway and the anti-apoptotic pathway through calcium-activated NF-κB and that inhibition of the latter by CsA may result in dominance of the apoptosis-inducing pathway. © 2003 Elsevier Science (USA). All rights reserved.

DOI： 10.1016/S0006-291X(03)00853-2

記述言語：日本語  

72歳女.diclofenac坐剤により終末回腸に出血性小潰瘍を発症し,絶食とNSAIDの減量,変更にて一度は軽快したが,再度の同座剤の投与により消化管穿孔を起こし緊急手術となった.症例2は94歳女.loxoprofen及びインドメタシン坐剤の投与により直腸から回腸への瘻孔を認め,便培養は陰性で生検で特異的な所見を認めず,NSAID起因性腸症を疑いNSAIDを中止し,1週間絶食したところ,NSAID中止後2ヵ月の大腸内視鏡検査では,依然として瘻孔は認めたものの,潰瘍は瘢痕化していた

記述言語：日本語  

64歳女.嘔吐,食事摂取不能を主訴とした.鉄欠乏性貧血を指摘されてから1年3ヵ月経過した後,主訴が出現して外来受診中,ショック状態を呈して緊急入院した.諸検査により十二指腸上行脚部の腸閉塞を成因とした嘔吐,水分摂取不良により著明な脱水症状をきたし,急性前性腎不全,著明な低Cl性代謝性アルカローシスとショックを呈したと診断した.多量輸液,胃管挿入による減圧を開始したところ,腎機能は回復してアルカローシスも改善した.腹部単純X線検査で小腸上部の閉塞機転が疑われた為,小腸X線検査,腹部CT,上部消化管内視鏡検査を行った結果,原発性空腸癌と診断された.開腹手術を施行して経過良好で,現在外来経過観察中である

記述言語：英語   掲載種別：研究論文（学術雑誌）  

1. To determine the mechanism of bradykinin-induced production of endothelium-derived contracting factors, we monitored the changes in cytosolic Ca2+ concentration ([Ca2+]i) in in situ endothelial cells in porcine aortic valvular strips and the changes in [Ca2+]i of smooth muscle cells and force in porcine interlobar renal arterial strips using front-surface fluorometry of fura-2. 2. In the presence of Nω-nitro-L-arginine methyl ester, bradykinin caused an endothelium-dependent transient elevation of [Ca2+]i and contraction in smooth muscle in the interlobar renal artery. This contraction was completely inhibited by a prostaglandin H2/thromboxane A2 receptor antagonist. 3. In the absence of extracellular Ca2+, bradykinin failed to induce contraction. However, replenishing extracellular Ca2+ to 0.75 mM and higher induced an instantaneous contraction. However, replenishing Ca2+ per se did not induce any contraction in the absence of bradykinin. Pretreatment with either 10-5 M 1-(β-(3-(4-methoxyphenyl)propoxy)-4-methoxyphenethyl)-1H-imidazole hydrochloride (SKF96365) or 0.2 mM Ni2+ abolished the contraction induced by bradykinin in the presence of extracellular Ca2+. 4. Treatment with 10-5 M indomethacin completely inhibited the contractile response induced by Ca2+ replenishment, regardless of the timing of its application, before or after the application of bradykinin. 5. In endothelial cells in the valvular strips, bradykinin caused a transient [Ca2+]i elevation in the presence of 1.25 mM extracellular Ca2+, but [Ca2+]i returned to the resting level within 10 min. Neither 10-5 M SKF96365 nor 0.2mM Ni2+ had any effect on the peak [Ca2+]i elevation, but decreased [Ca2+]i in the declining phase. In the absence of extracellular Ca2+, bradykinin induced a transient [Ca2+]i elevation to a level similar to that seen in the presence of 1.25 mM extracellular Ca2+. However, [Ca2+]i then rapidly returned to the prestimulation level within 5 min. Subsequent Ca2+ replenishment to 0.75 mM and higher in the presence of bradykinin elevated [Ca2+]i to significantly higher levels than the resting level seen in the media containing 1.25 mM Ca2+. 6. In conclusion, Ca2+ influx in the endothelial cells is essential for bradykinin to induce endothelium-dependent contraction in the porcine interlobar renal artery.

DOI： 10.1111/j.1469-7793.2001.t01-1-00701.x

記述言語：日本語  

48歳女.精神分裂病のため通院中であったが,自殺目的で住居用洗剤2種類を服用し,意識障害が認められて搬送された.上部消化管内視鏡検査で,前庭部に巨大な地図状潰瘍を認め,潰瘍は黄白色調の厚く汚い白苔に被われていた.胃体部に縦走する潰瘍を数条認め,粘膜は浮腫状に腫脹していた.生理用食塩水10lで胃洗浄を行い,絶食・輸液・H2受容体拮抗剤投与により保存的治療を行ったところ,全身状態・意識状態は徐々に改善した.第30病日,前庭部・胃角部に偽憩室形成を伴う著明な変形・狭窄を認め,それらはその後も残存した.経過観察を継続したが,胃体部の進展は良好で,通過障害等の消化器症状は認めていない.住居用洗剤による腐食性胃炎の報告は少ないが,アルカリ性物質,界面活性剤の粘膜刺激作用により,前庭部に変形・狭窄をきたすことがある為,早期の内視鏡検査,適切な治療および経過観察が必要である

記述言語：英語  

記述言語：日本語  

記述言語：その他   掲載種別：研究論文（学術雑誌）  

A 48-yr-old man was admitted to our hospital with abdominal discomfort and distension. A barium enema showed multiple radiolucent filling defects in the wall of the ascending colon. Colonic endoscopy revealed numerous round, polypoid masses covered with normal mucosa. These findings suggested Pneumatosis cystoides intestinalis. Target air-enema computed tomography was performed to make a final diagnosis, and demonstrated several gas collections covered with soft tissue in the wall of the ascending colon. This is the first reported case of Pneumatosis cystoides intesinalis in which multiple gas-filled cysts could be recognized by target air-enema computed tomography.

DOI： 10.1111/j.1572-0241.1998.354_q.x

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

34歳女.長期間の多飲歴のある為に,初回の水制限試験では中枢性部分型尿崩症と考えられた心因性多飲症症例を報告した.両者の鑑別は時間をかけて慎重に行う必要がある

記述言語：日本語   著書種別：学術書

なし

開催年月日： 2018年6月

記述言語：英語  

開催地：Washington DC   国名：アメリカ合衆国  

開催年月日： 2018年6月

記述言語：英語  

開催地：Washington DC   国名：アメリカ合衆国  

開催年月日： 2018年6月

記述言語：英語  

開催地：Washington DC   国名：アメリカ合衆国  

開催年月日： 2018年6月

記述言語：英語  

開催地：Washington DC   国名：アメリカ合衆国  

開催年月日： 2018年6月

記述言語：英語  

開催地：Washington DC   国名：アメリカ合衆国  

開催年月日： 2017年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Chicago   国名：アメリカ合衆国  

開催年月日： 2017年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Chicago   国名：アメリカ合衆国  

開催年月日： 2017年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Chicago   国名：アメリカ合衆国  

開催年月日： 2016年8月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：仙台   国名：日本国  

開催年月日： 2016年8月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：仙台   国名：日本国  

開催年月日： 2016年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：San Diego   国名：アメリカ合衆国  

開催年月日： 2016年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：San Diego   国名：アメリカ合衆国  

開催年月日： 2016年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：San Diego   国名：アメリカ合衆国  

開催年月日： 2016年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：San Diego   国名：アメリカ合衆国  

開催年月日： 2016年4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）  

開催地：東京   国名：日本国  

開催年月日： 2016年2月 - 2016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）  

開催地：東京   国名：日本国  

開催年月日： 2015年10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）  

開催地：東京   国名：日本国  

開催年月日： 2015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）  

開催地：名古屋   国名：日本国  

開催年月日： 2015年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Washington DC   国名：アメリカ合衆国  

開催年月日： 2015年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Washington DC   国名：アメリカ合衆国  

開催年月日： 2015年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Washington DC   国名：アメリカ合衆国  

開催年月日： 2015年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Washington DC   国名：アメリカ合衆国  

開催年月日： 2015年4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）  

開催地：仙台   国名：日本国  

開催年月日： 2015年4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）  

開催地：仙台   国名：日本国  

開催年月日： 2015年2月 - 2015年3月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Banff, AB   国名：カナダ  

開催年月日： 2014年10月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Vienna   国名：オーストリア共和国  

開催年月日： 2014年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Chicago, IL   国名：アメリカ合衆国  

開催年月日： 2014年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：chicago, IL   国名：日本国  

開催年月日： 2013年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Orland, FL, USA   国名：日本国  

Trypsin induced biphasic contraction and relaxation in the porcine lower esophageal sphincter.

開催年月日： 2012年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：San Diego, CA   国名：アメリカ合衆国  

Background and study aim: Endoscopic submucosal dissection (ESD)-associated techniques have been used in Japan for tissue sampling of suspected gastrointestinal stromal tumors (GISTs) instead of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The aim of the present report was to evaluate the diagnostic yield and sensitivity of this procedure, which we named mucosal incision assisted biopsy (MIAB), for the histological diagnosis of gastric submucosal tumor (SMT). Patients and methods: We performed a retrospective review of the 15 patients with suspected gastric GIST who underwent MIAB in our hospitals between January 2010 and March 2011. This technique involved making a mucosal incision in the same way as the circumferential mucosal incision is made for ESD, followed by careful submucosal dissection until a portion of the lesion was exposed, and taking biopsy specimens under direct vision. Results: Tissue samples obtained by MIAB were sufficient for us to make a histological diagnosis of the gastric SMTs in 13 of the 15 patients. There were no significant differences in age, sex, SMT location or SMT size between diagnostic and non-diagnostic MIAB groups of patients, but there was a significant difference in SMT growth patterns between the groups (p < 0.05). Conclusions: Although it is generally accepted that EUS-FNA is the gold standard for obtaining tissue specimens for histological and cytological analysis of suspected gastric GISTs, MIAB can be used as an alternative method for obtaining biopsy specimens of lesions with an intraluminal growth pattern.

開催年月日： 2012年5月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：San Diego, CA   国名：アメリカ合衆国  

開催年月日： 2011年7月 - 2011年8月

会議種別：口頭発表（一般）  

開催地：kyoto   国名：日本国  

ERK and p38MAPK regulate myosin light chain phosphatase and contribute to carbachol-induced contraction in rat intestinal smooth muscle.

開催年月日： 2009年5月 - 2009年6月

会議種別：口頭発表（一般）  

開催地：Chicago, IL   国名：アメリカ合衆国  

Hypoxia Inducible Factor (HIF-1alpha) Plays a Critical Innate Protective Role in Clostridium Difficile (Cdif) Toxin-Induced Intestinal Injury and Inflammation.

開催年月日： 2009年2月 - 2009年3月

会議種別：口頭発表（一般）  

開催地：Banff, AB   国名：カナダ  

Pharmacological stabilization of HIF-1a is protective in a mouse model of clostridium difficile-associated intestinal inflammation.

開催年月日： 2009年2月 - 2009年3月

会議種別：口頭発表（一般）  

開催地：Banff, AB   国名：カナダ  

Protein kinase signaling pathways contribute to hypercontractility in murine experimental colitis.

開催年月日： 2008年5月

会議種別：口頭発表（一般）  

開催地：San Diego, CA   国名：アメリカ合衆国  

Up-regulation of HIF-1alpha is associated with augmented Rho-kinase-mediated contraction of ileal smooth muscle following exposure to Clostridium difficile toxins in a mouse ileal loop model.

開催年月日： 2008年2月

会議種別：口頭発表（一般）  

開催地：Montreal, PQ   国名：カナダ  

Ca2+-sensitization of colonic smooth muscle is altered in a murine experimental colitis model.

開催年月日： 2008年2月

会議種別：口頭発表（一般）  

開催地：Montreal, PQ   国名：カナダ  

Alterations in the contractile properties of ileal smooth muscle exposed to Clostridium difficile toxins: the involvemen

開催年月日： 2007年10月

会議種別：口頭発表（一般）  

開催地：Paris   国名：フランス共和国  

Colonic smooth muscle contractile dysfunction in experimental colitis and its underlying mechanisms.

開催年月日： 2007年2月

会議種別：口頭発表（一般）  

開催地：Banff, AB   国名：カナダ  

Protein kinases responsible for Ca2+-independent contraction of intestinal smooth muscle.

開催年月日： 2006年7月 - 2006年8月

会議種別：口頭発表（一般）  

開催地：Snowmass, CO   国名：アメリカ合衆国  

Exploration of protein kinases responsible for Ca2+-independent, microcystin-induced contraction in intestinal smooth muscle.

開催年月日： 2002年10月

会議種別：口頭発表（一般）  

開催地：Geneva   国名：スイス連邦  

The Useful Approach to Obstructing or Stenotic Lesions in the Distal Ileum by Retrograde Ileography.

開催年月日： 1999年5月

会議種別：口頭発表（一般）  

開催地：Nagoya City   国名：日本国  

Endothelium-dependent triphasic regulation of vascular tone induced by bradykinin in the porcine renal artery.

記述言語：英語   会議種別：口頭発表（一般）  

開催地：San Diego, CA   国名：アメリカ合衆国  

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）  

開催地：鹿児島   国名：日本国  

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）  

開催地：東京   国名：日本国  

開催年月日： 2024年2月

記述言語：英語  

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