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Abstract Background/aims The prevalence of ulcerative colitis (UC) has been increasing, also in older adults. Here, we retrospectively compared the efficacy and safety of tacrolimus (TAC) in older and younger patients with UC. Methods We included younger (age

Abstract A 60‐year‐old man presented with a suspected small intestinal tumor on positron‐emission tomography‐computed tomography. Small bowel capsule endoscopy (SBCE) was planned for close examination of the small intestine. To avoid retention of the SBCE due to strictures, a patency capsule (PC) was first used to evaluate patency. However, PC discharge was not visually confirmed during the 24‐h period. No obvious PC was observed on plain abdominal radiography performed in the standing position. The patient underwent SBCE, assuming that the PC had been shed inconspicuously. SBCE revealed a neoplastic lesion with stenosis at a site thought to be the upper small intestine and remained stagnant at the same site for the duration of the battery. In addition, in the SBCE image, a PC shell was captured in the intestinal tract on the oral side of the stenosis. When the pre‐SBCE plain abdominal radiograph was enlarged to confirm the details, PC was observed in the lateral and decubitus views as a dissolved shell only. To the best of our knowledge, no previous report has described the complete dissolution of a PC leaving only its shell during a 30‐hour patency evaluation period. This case illustrates that, in the absence of visual confirmation of a PC discharge, PC may have remained in the body due to premature dissolution. Additional examinations or plain X‐ray imaging should be performed to confirm this, with no preconceived notions that the PC will not dissolve within 30 hours of administration.

Introduction: Small bowel (SB) capsule endoscopy (SBCE) is a sensitive modality for screening the entire SB of patients with Crohn’s diseases (CD); however, the prognostic impact of the results is unclear. We evaluated the ability of the SBCE score to predict therapeutic intervention for patients with CD and SB lesions without clinical symptoms as well as negative C-reactive protein (CRP) levels. Methods: Fifty-six patients who underwent a patency evaluation and had a CD activity index (CDAI) score

The patient was a woman in her 40s who was diagnosed with Crohn’s disease (CD) of the large and small intestines in 1996. In 2005, she was referred to our hospital for treatment. We treated her for 17 years with corticosteroids, biologics, immunosuppressive agents, 5-aminosalicylic acid, and nutrition care. However, her Crohn’s Disease Activity Index remained between 200 and 250, indicating refractory CD. During her medical treatment, the patient also underwent 3 operations. One year ago, the patient became pregnant through in vitro fertilization. Even after pregnancy was confirmed, the patient continued her treatment for refractory CD with ustekinumab, granulocyte apheresis, and budesonide. Nonetheless, her CD was highly active during pregnancy, and she experienced various complications: sigmoid volvulus at gestational week 15, venous thrombosis at gestational week 17, nontraumatic rib fracture due to fetal movement at gestational week 32, and sepsis from central venous catheter infection at gestational week 37. At gestational week 38, the patient gave birth by emergency cesarian delivery. This paper reports details of the case in which delivery was achieved after various complications were overcome and discusses previous relevant reports.

We treated a 39-year-old Japanese man who was admitted for an abdominal mass. He had had neurofibroma-like skin lesions since childhood. Computed tomography and endoscopic ultrasound results were consistent with a tumor in the small intestine. Although the tumor was undetectable by single-balloon endoscopy, the patient’s background and imaging results led us to suspect a gastrointestinal stromal tumor (GIST). He also met the diagnostic criteria for neurofibroma type 1 (NF1). We performed a surgical removal of the tumor, and the biopsy results led to a definitive diagnosis of GIST. Small bowel GISTs should be considered in cases of NF1.

Abstract Background Lymphangioma is a non-epithelial tumor marked by aggregates of abnormally dilated lymphatics. Mesenteric occurrences account for

Coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now a pandemic. Although several treatment guidelines have been proposed for patients who have both inflammatory bowel disease and COVID-19, immunosuppressive therapy is essentially not recommended, and the treatment options are limited. Even in the COVID-19 pandemic, adjuvant adsorptive granulocyte and monocyte apheresis may safely bring ulcerative colitis (UC) into remission by removing activated myeloid cells without the use of immunosuppressive therapy. Our patient was a 25-year-old Japanese male with UC and COVID-19. This is the first case report of the induction of UC remission with granulocyte and monocyte apheresis treatment for active UC associated with COVID-19.

Objective. Intestinal motility may be different in obese and nonobese patients, but this has not been determined. Here, we sought to evaluate the effect of obesity on small bowel capsule endoscopy (SBCE). Patients and Methods. We retrospectively analyzed the cases of the 340 patients who underwent SBCE for small intestinal disease (excluding cases of unobservable total small bowel, small bowel stenosis, and bowel resection) at our hospital during the period January 2014 to December 2020 to extract patient background factors and the bowel transit times of SBCE according to the presence/absence of obesity (defined as a body mass index BMI≥25 kg/m2). Results. The obese group was 54 patients (nonobese, n=286). The small bowel transit time (SBTT) was significantly shorter in the obese patients compared to the nonobese patients (p=0.0026), and when we divided the patients by their short/long SBTTs using 216.5 min as the cutoff, we observed significant between-group differences in the patients’ age (≥60 years) and in the patients’ hospitalization status at the time of the SBCE examination. A multivariate analysis revealed that hospitalized status at the examination is a factor contributing significantly to a long SBTT (OR 0.25, 95% CI: 0.15–0.42, p