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An 82-year-old man with abdominal pain was admitted to our hospital. Laboratory tests revealed the following:white blood cells, 14300/μl;serum hemoglobin level, 12.9g/dl;serum C-reactive protein level, 0.38mg/dl;and negative anti-Helicobacter pylori immunoglobulin G test. Abdominal computed tomography revealed a tumor in the appendix along with multiple swollen lymph nodes. Colonoscopy revealed a submucosal tumor (SMT) of approximately 30mm in diameter with central ulceration. However, a tumor tissue specimen could not be obtained for biopsy;thus, the tumor could not be diagnosed. In esophagogastroduodenoscopy, abnormalities or gastric mucosal atrophy was not observed. A rapid urease test yielded negative results. Hence, endoscopic ultrasound-guided fine needle aspiration for the SMT was recommended;however, the patient preferred to undergo a definitive surgery to establish exact diagnosis. Therefore, right hemicolectomy and lymph node dissection (D3) were performed. Histopathologically, the resected tumor specimen showed atypical lymphocytes. Additionally, immunohistochemical evaluation demonstrated positive staining of the tumor cells for CD20 and BCL2 and negative staining for CD34, CD4, CD10, and BCL6. The tumor was finally diagnosed as a stage II 2 mucosa-associated lymphoid tissue lymphoma (Lugano classification). Postoperatively, the patient received chemotherapy with four cycles of rituximab based on his age and activities of daily living.

Although chronic constipation is highly prevalent, its definition remains unclear. Therefore, the prevalence varies depending on reports, and the understanding of actual situations is unclear. Hence, we performed an internet survey on constipation among the Japanese general population to study the background factors and actual situations. Preliminary study on the awareness of constipation was conducted among 10000 people in which 9523 of them was asked if they had constipation at the time of the survey. In this population, 51.5% realized that they had constipation. Multivariate analysis showed the significant association of constipation to age, sex, and past histories or complications of diabetes, hemorrhoids, and cerebrovascular diseases. In a main research composed of 3000 general Japanese population, approximately 30.9% of the subjects reported the use of laxatives to treat constipation, and 43.8% of them were found to use irritant laxatives. Moreover, 67.5% of the subjects purchased laxatives at a pharmacy. The frequency of bowel movement less than 3 times per week was manifested in 36.3% of the subjects, and more than once per week in 21.4%. The percentage of hard (Bristol Stool Form Scale [BSFS] Type 1-2), normal (BSFS Type 3-5), and diarrhea stools (BSFS Type 6-7) was 33.1%, 60.0%, and 6.9%, respectively. The quality of life (QOL) of the subjects with hard and diarrhea stools evaluated by SF-8 was significantly lower than that of those with normal stools. Furthermore, the actual monthly cost for the therapeutic drugs used for treating constipation was less than 1000 yen in 75% of the subjects. Analysis of the IBS-QOL-J indicated that the ≥5000 yen payable group had the lowest satisfaction of defecation among the study groups. At present, many Japanese patients with constipation have not been receiving enough treatment for constipation. Therefore, appropriate medication by physicians as well as instruction to patients is required.

Non-erosive reflux disease (NERD) is characterized by the absence of esophageal mucosal damage during upper gastrointestinal endoscopy, despite the presence of typical symptoms of gastroesophageal reflux, such as heartburn and acid reflux. Almost 50 % of patients with NERD fail to respond to standard doses of proton pump inhibitors which are the first-line ther- apy for GERD. This means that acid reflux is only a minor effect on the pathophysiological mechanism of NERD and various mechanisms such as visceral hypersensitivity, esophageal motor abnormalities, weak or non-acid reflux and psychic effect have been estimated. There- fore, it is important to evaluate the pathophysiology of NERD by esophageal functional tests and to create the therapeutic strategy for each patients.

Non-erosive reflux disease (NERD) is characterized by the absence of esophageal mucosal damage during upper gastrointestinal endoscopy, despite the presence of typical symptoms of gastroesophageal reflux, such as heartburn and acid reflux. In addition, acid reflux is known to have only a minor effect on the pathophysiological mechanism of NERD. For this reason, NERD patients who receive proton pump inhibitors (PPIs), which are the first-line therapy for GERD, show a low symptom improvement rate, and almost 50% of NERD patients fail to respond to standard acid-suppression therapy that uses PPIs. Therefore, it is important to evaluate the pathophysiology of NERD and to create the therapeutic strategy for each patients.

A 53-year-old man was admitted to our hospital with anterior chest pain and difficulty swallowing. Computed tomography revealed significant esophageal wall thickening. Esophageal intraluminal manometry revealed uncoordinated contraction and strong peristaltic pressure associated with the chest pain. The patient was subsequently diagnosed with diffuse esophageal spasm (DES). His serum immunoglobulin E level was high, and peripheral blood eosinophilia was observed. No eosinophilic infiltration was detected in the esophageal mucosa on endoscopic biopsy. It was presumed that this case of DES was induced by allergic disease. Treatment with 30 mg of oral prednisolone led to a prompt resolution of symptoms;the thickness of the esophageal wall decreased, and the simultaneous contractions disappeared. However, given the presence of a strong peristaltic wave, nutcracker esophagus (NE) was also suspected. This was a rare case of atypical DES induced by allergic disease and associated with NE.

A novel [18F]FRP-170 injection for imaging hypoxia by PET was developed for clinical use. The preparation was based on the simple on-column basic-hydrolysis and the whole procedure was automated by detecting He flow change for transferring and evaporating liquids. [18F]FRP-170 was prepared in around 15-20% decay-corrected radiochemical yield within 60 min and stable in saline for more than 6 hr. Radiochemical purity was over 99% and specific activity at EOS was 40-60 GBq/micromol. The radiation-absorbed dose to the whole body was estimated to be 1.0 mSv/185 MBq. The [18F]FRP-170 injection proved to be suitable for clinical use without acute toxicity or mutagenicity.

Effect of methylprednisolone on the emesis of patients treated with CDDP was examined by randomized control trial. Methylprednisolone showed no effect on the frequency of vomiting on the day of CDDP administration as well as on the duration of nausea and anorexia after CDDP treatment.

The effect of high-dose metoclopramide (2 mg/kg, 4 times every 2 hours) on the emesis of patients treated with CDDP (80 mg/m2) was examined by randomized control trial. The above metoclopramide regimen significantly suppressed the frequency of vomiting on the day of CDDP administration. The duration of nausea and anorexia after CDDP treatment was also shortened by high-dose metoclopramide administration.