Search

Clinical, pathological, and virological analysis including hypervariable region-1 of hepatitis C virus (HCV) was performed to predict the effect of interferon (IFN) on 41 patients with chronic hepatitis type C. The low virus load, low frequency of the mutation in the hypervariable region-1 as the change of amino acid and high level of serum aminotransferase make one estimate the good effect of IFN on patients with HCV. Mutation in the hypervariable region-1 of HCV measured by fast assay fluorescence single-stranded conformational polymorphism was more frequent in nonresponders to IFN than responders. The most frequently mutated position was amino acid number 406. This indicates that the specific mutation site might affect the response of IFN. [ABSTRACT FROM AUTHOR]

Previous study showed that phospholipids concentration in the gastric mucosa decreased in the patients of Helicobacter priori (H. pylori) infection and the patients of liver cirrhosis induced gastritis. In contrast, we previously demonstrated that phospholipids concentration decreased in patients with peptic ulcer regardless of H. priori infection. The aim of this study was to examine an effect of eradiation of H. pylori on mucosal phospholipids in peptic ulcer. Methods: The endoscopic biopsy specimens were obtained from the antral and corporal mucosa of patients. Phospholipids (phosphatidylcholine:PC, phosphatidylethanolamine:PE, and sphingonomyeline:SM) were measured quantitatively in the lipid extract from the biopsy specimens according to thin-layer chromatography and flame ionization detection method. We examined 3 groups: gastric ulcer, n=26; duodenal ulcer, n=13; age-matched H. priori negative control, n=20. Eradication was performed by lansoprazole 30 mg b.d., amoxicillin 500 mg t.d., and clarithromycin 400 mg b.d for seven days. Three months after the eradication, the endoscopic biopsy specimens obtained. Results: Compared to the H. pylori negative control group, contents of PC and PE decreased significantly in the gastric ulcer group in both antral and corporeal mucosa. This decrease returned to the control level after the eradication. In the duodenal ulcer group, the decrease in the mucosal content of PC and PE was observed only in the antral mucosa, but not in the corporal mucosa. The decrease in the antral mucosal phospholipids in the duodenal ulcer group was returned to the control level after the eradication of H. pylori. The mucosal content of SM did not differ in the three tested groups. Conclusion: This study demonstrated that the eradication of H. pylori in patients with peptic ulcer normalized the decrease in PC and PE in the gastric mucosa. Eradication of H. pylori could lessen the deterioration of the protective system of the gastric mucosa. [ABSTRACT FROM AUTHOR]

Introduction: Recently, many studies have suggested that Helicobacter pylori (H. pylori) infection might be a protecting factor for gastroesophageal reflux disease (GERD), although the results are conflicting. In this study, we examined complication of reflux esophagitis for peptic ulcer in large population and this rate was compared to patients of peptic ulcer with eradication of H. pylori. Methods: 1) Endoscopic evaluation of 8,031 Japanese adults without medication was performed. 2) Gastric or duodenal ulcer patients with H. pylori infection was eradicated, and endoscopic examination was performed before and 3 months after eradication. Eradication was performed with lansoprazole 60 mg, amoxicillin 1500 mg and clarithromycin 800 mg for seven days. All patients were asked regarding nausea, abdominal pain, and GERD related symptoms including heart burn, dysphagia, and acid regurgitation. Results: Among 8,031 adults, a complication rate of esophagitis for gastric ulcer was 13.8%, and for duodenal ulcer was 6.7%. Before and after eradication, 153 patients were analyzed. H. pylori was successfully eradicated in 58 out of 81 patients with gastric ulcer (71.6%), and in 37 out of 52 patients with duodenal ulcer (71.1%). Before eradication, 11 (13.6%) of 81 gastric ulcer patients and 9 (17.6%) of 52 duodenal ulcer patients have GERD symptoms and/or endoscopic esophagitis. Increase in the number of esophagitis was 0 in the gastric ulcer group, and 3 in the duodenal ulcer group. Conclusion: Increase in esophagitis after eradication was not significant compared to the complication rate of peptic ulcer and esophagitis in 8,031 Japanese adults. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to investigate the characteristics of bleeding peptic ulcer in Japan, including the role of H. pylori infection and NSAIDs use. Patients and Methods: This study was prospectively intended for patients who have a bleeding peptic ulcer at emergent endoscopy in our hospital in 1998 to 2001. We grouped these patients by H. pylori infection and NSAIDs use, and examined backgrounds of patients; i.e., age, sex, underlying disease, location of ulcer. Results: We devided 128 patients with bleeding gastric or duodenal ulcer into 4 groups. Group A (71, 55.5%); H. pylori (+), NSAIDs (-). Group B (10, 7.8%); H. pylori (+), NSAIDs (+). Group C (14, 10.9%); H. pylori (-), NSAIDs (+). Group D (33, 25.8%); H. pylori (-), NSAIDs (-). Age in patients with use of NSAIDs was high (Group B and C). In Group C, females were more than males. Corporeal ulcer of group D was higher than that of group A. Duodenal ulcer of group A was higher than that in other groups. Most of patients with Group B, C, had underlying disease compared to patients with H. pylori related ulcer (Group A). But, the underlying disease of Group D was more severe than that of Group B and C. Contents of underlying diseases were liver cirrhosis, congestive heart failure, and coronary disease. Rebleeding cases were 5 of all, and each case were gastric ulcer. Death cases were 5 of all the patients, and the causes of the death were due to severe underlying diseases. Conclusions: In Japan, The patients who have bleeding peptic ulcer without H. pylori infection and NSAIDs use were relatively high compared to that with H. pylori infection. And one of the characteristics in these patients was to have severe underlying disease. [ABSTRACT FROM AUTHOR]

Background: This study investigated clinicopathological factors associated with the visibility of early gastric cancer and the efficacy of linked color imaging., Methods: Patients with early gastric cancer who underwent endoscopic treatment between April 2021 and July 2022 were enrolled. All cases underwent white light imaging and linked color imaging. Three experts evaluated lesion visibility using a visual analog scale. A mean score ≥3 on white light imaging was defined as "good visibility", and <3 as "poor visibility". We extracted patient information and endoscopic and pathological data for the lesion and background mucosa, analyzed factors associated with the visibility of early gastric cancer, and compared visibility between white light imaging and linked color imaging., Results: Ninety-seven lesions were analyzed, with good visibility in 49 and poor visibility in 48. Multivariate analysis revealed small lesion size (odds ratio 1.89) and presence of endoscopic intestinal metaplasia (odds ratio 0.49) as significantly associated with the poor visibility of early gastric cancer. Mean visibility score was significantly higher for linked color imaging (P<0.001). Mean score for linked color imaging was significantly higher in the poor visibility group (P<0.001), but not significantly different in the good visibility group (P = 0.292). Mean score was significantly higher with linked color imaging in cases with endoscopic intestinal metaplasia (P = 0.0496) and lesions <20 mm in diameter (<10 mm, P = 0.002; 10-20 mm, P = 0.004)., Conclusions: Lesion size and endoscopic intestinal metaplasia are associated with the visibility of early gastric cancer in white light imaging. Linked color imaging improves visibility of gastric cancer with these factors., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Fukuda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: For early gastrointestinal lesions, size is an important factor in the selection of treatment. Virtual scale endoscope (VSE) is a newly developed endoscope that can measure size more accurately than visual measurement. This study aimed to investigate whether VSE measurement is accurate for early gastrointestinal lesions of various sizes and morphologies., Methods: This study prospectively enrolled patients with early gastrointestinal lesions ≤20 mm in size visually. Lesion sizes were measured in the gastrointestinal tract visually, on endoscopic resection specimens with VSE, and finally on endoscopic resection specimens using a ruler. The primary endpoint was the normalized difference (ND) of VSE measurement. The secondary endpoints were the ND of visual measurement and the variation between NDs of VSE and visual measurements. ND was calculated as (100 × [measured size - true size] / true size) (%). True size was defined as size measured using a ruler., Results: This study included 60 lesions from April 2022 to December 2022, with 20 each in the esophagus, stomach, and colon. The lesion size was 14.0 ± 6.3 mm (mean ± standard deviation). Morphologies were protruded, slightly elevated, and flat or slightly depressed type in 8, 24, and 28 lesions, respectively. The primary endpoint was 0.3 ± 8.8%. In the secondary endpoints, the ND of visual measurement was -1.7 ± 29.3%, and the variability was significantly smaller in the ND of VSE measurement than in that of visual measurement ( p < 0.001, F-test)., Conclusions: VSE measurement is accurate for early gastrointestinal lesions of various sizes and morphologies., Competing Interests: Hiroaki Ikematsu is an Associate Editor of DEN Open. The other authors declare no conflict of interest., (© 2024 The Authors. DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)

Background: Linked color imaging (LCI) is a new image enhancement technology that facilitates the recognition of subtle differences in mucosal color. In the large-scale, multicenter randomized controlled trial LCI-FIND, LCI demonstrated good diagnostic performance for the detection of tumor lesions in the upper gastrointestinal tract. The aim of the present study was to exploratively evaluate the diagnostic performance of LCI according to H. pylori infection status as a subanalysis of LCI-FIND trial., Methods: The patients were randomly allocated to receive white light imaging (WLI) first, followed by LCI (WLI group), or vice versa (LCI group), and the two groups were compared for the detection of tumors. Data from this trial were analyzed by the presence/absence of H. pylori infection and further analyzed by successful or unsuccessful eradication in the H. pylori infection group., Results: The 752 patients in the WLI group and 750 patients in the LCI group who had participated in the LCI-FIND trial were included. In the successful eradication group, more gastric lesions were detected by primary mode in the LCI group than in the WLI group, indicating that more lesions were missed by WLI. Fisher's exact probability test for the comparison of the WLI and LCI groups yielded a p-value of 0.0068, with missed gastric lesions being detected 0.136 times (95% confidence interval: 0.020-0.923), significantly less with LCI than with WLI., Conclusion: The current study suggests that LCI should be used for gastric cancer screening, particularly in patients with successful H. pylori eradication., (© 2024 John Wiley & Sons Ltd.)

Background: Sodium picosulfate (SP)/magnesium citrate (MC) and polyethylene glycol (PEG) plus ascorbic acid are recommended by Western guidelines as laxative solutions for bowel preparation. Clinically, SP/MC has a slower post-dose defaecation response than PEG and is perceived as less cleansing; therefore, it is not currently used for major bowel cancer screening preparation. The standard formulation for bowel preparation is PEG; however, a large dose is required, and it has a distinctive flavour that is considered unpleasant. SP/MC requires a small dose and ensures fluid intake because it is administered in another beverage. Therefore, clinical trials have shown that SP/MC is superior to PEG in terms of acceptability. We aim to compare the novel bowel cleansing method (test group) comprising SP/MC with elobixibat hydrate and the standard bowel cleansing method comprising PEG plus ascorbic acid (standard group) for patients preparing for outpatient colonoscopy., Methods: This phase III, multicentre, single-blind, noninferiority, randomised, controlled, trial has not yet been completed. Patients aged 40-69 years will be included as participants. Patients with a history of abdominal or pelvic surgery, constipation, inflammatory bowel disease, or severe organ dysfunction will be excluded. The target number of research participants is 540 (standard group, 270 cases; test group, 270 cases). The primary endpoint is the degree of bowel cleansing (Boston Bowel Preparation Scale [BBPS] score ≥ 6). The secondary endpoints are patient acceptability, adverse events, polyp/adenoma detection rate, number of polyps/adenomas detected, degree of bowel cleansing according to the BBPS (BBPS score ≥ 8), degree of bowel cleansing according to the Aronchik scale, and bowel cleansing time., Discussion: This trial aims to develop a "patient-first" colon cleansing regimen without the risk of inadequate bowel preparation by using both elobixibat hydrate and SP/MC., Trial Registration: Japan Registry of Clinical Trials (jRCT; no. s041210067; 9 September 2021; https://jrct.niph.go.jp/ ), protocol version 1.5 (May 1, 2023)., (© 2024. The Author(s).)

Purpose: Growing concern exists worldwide about stress-related mental disorders, such as posttraumatic stress disorder (PTSD), often linked to hippocampal dysfunctions. Recognizing this connection, regular light-intensity exercise (LIE)-such as yoga, walking, or slow jogging-may offer a solution. Easily accessible even to vulnerable individuals, LIE has been found to enhance hippocampus-based cognitive functions through the stimulation of neurotrophic factors like brain-derived neurotrophic factor (BDNF). A prior study that demonstrated BDNF's role in extinguishing original fear memory further leads us to propose that a consistent LIE training might drive fear extinction learning, offering potential therapeutic benefits through BDNF signaling., Methods: Eleven-week-old Wistar rats underwent 4 wk of training under conditions of sedentary, LIE, or moderate-intensity exercise (MOE) after contextual or auditory fear conditioning. Subsequently, fear extinction tests were performed. We then administered intraperitoneal (i.p.) ANA-12, a selective antagonist of tropomyosin receptor kinase B (TrkB), or a vehicle to explore the role of BDNF signaling in exercise-induced fear extinction among the LIE rats. Following the regular exercise training, further fear extinction tests were conducted, and hippocampal protein analysis was performed using Western blotting., Results: Both LIE and MOE over 4 wk accelerated hippocampus-associated contextual fear extinction compared with sedentary. In addition, 4 wk of LIE with i.p. administered vehicle increased hippocampal BDNF and TrkB protein levels. In contrast, i.p. ANA-12 administration fully blocked the LIE-enhanced protein levels and its effect on contextual fear extinction., Conclusions: Our findings reveal that LIE regimen promotes fear extinction learning, at least partially tied to hippocampal BDNF-TrkB signaling. This suggests that even regular light exercise could alleviate the excessive fear response in anxiety disorders and PTSD, providing hope for those affected., (Copyright © 2023 by the American College of Sports Medicine.)

Background & Aims: Reported rates of delayed bleeding (DB) after endoscopic resection using direct oral anticoagulants (DOACs) are high and heterogeneous. This large-scale multicenter study analyzed cases of DB after colorectal endoscopic submucosal dissection related to various types of DOACs in Japan (the ABCD-J study) with those associated with warfarin., Methods: We retrospectively reviewed 1019 lesions in patients treated with DOACs and 459 lesions in patients treated with warfarin among 34,455 endoscopic submucosal dissection cases from 47 Japanese institutions between 2012 and 2021. The DB rate (DBR) with each DOAC was compared with that with warfarin. Risk factors for DB in patients treated with DOACs or warfarin were also investigated., Results: The mean tumor sizes in the DOAC and warfarin groups were 29.6 ± 14.0 and 30.3 ± 16.4 mm, respectively. In the DOAC group, the DBR with dabigatran (18.26%) was significantly higher than that with apixaban (10.08%, P = .029), edoxaban (7.73%, P = .001), and rivaroxaban (7.21%, P < .001). Only rivaroxaban showed a significantly lower DBR than warfarin (11.76%, P = .033). In the multivariate analysis, heparin bridging therapy (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.27-3.73, P = .005), rectal location (2.01, 1.28-3.16, P = .002), and procedure time ≥55 minutes (2.43, 1.49-3.95, P < .001) were significant risk factors for DB in the DOAC group. The DB risk in the DOAC group (OR, (95% CI)) was 2.13 (1.30-3.50) and 4.53 (2.52-8.15) for 1 and 2 significant risk factors, respectively., Conclusions: Dabigatran was associated with a higher DBR than other DOACs, and only rivaroxaban was associated with a significantly lower DBR than warfarin., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Objective: This study was performed to evaluate whether the use of CAD EYE (Fujifilm, Tokyo, Japan) for colonoscopy improves colonoscopy quality in gastroenterology trainees., Methods: The patients in this multicenter randomized controlled trial were divided into Group A (observation using CAD EYE) and Group B (standard observation). Six trainees performed colonoscopies using a back-to-back method in pairs with gastroenterology experts. The primary end-point was the trainees' adenoma detection rate (ADR), and the secondary end-points were the trainees' adenoma miss rate (AMR) and Assessment of Competency in Endoscopy (ACE) tool scores. Each trainee's learning curve was evaluated using a cumulative sum (CUSUM) control chart., Results: We analyzed data for 231 patients (Group A, n = 113; Group B, n = 118). The ADR was not significantly different between the two groups. Group A had a significantly lower AMR (25.6% vs. 38.6%, P = 0.033) and number of missed adenomas per patient (0.5 vs. 0.9, P = 0.004) than Group B. Group A also had significantly higher ACE tool scores for pathology identification (2.26 vs. 2.07, P = 0.030) and interpretation and identification of pathology location (2.18 vs. 2.00, P = 0.038). For the CUSUM learning curve, Group A showed a trend toward a lower number of cases of missed multiple adenomas by the six trainees., Conclusion: CAD EYE did not improve ADR but decreased the AMR and improved the ability to accurately locate and identify colorectal adenomas. CAD EYE can be assumed to be beneficial for improving colonoscopy quality in gastroenterology trainees., Trial Registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN000044031)., (© 2023 The Authors. Digestive Endoscopy published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)

Background & Aims: We aimed to clarify the long-term outcomes of endoscopic resection (ER) for early gastric cancers (EGCs) based on pathological curability in a multicenter prospective cohort study., Methods: We analyzed the long-term outcomes of 9054 patients with 10,021 EGCs undergoing ER between July 2010 and June 2012. Primary endpoint was the 5-year overall survival (OS). The hazard ratio for all-cause mortality was calculated using the Cox proportional hazards model. We also compared the 5-year OS with the expected one calculated for the surgically resected patients with EGC. If the lower limit of the 95% confidence interval (CI) of the 5-year OS exceeded the expected 5-year OS minus a margin of 5% (threshold 5-year OS), ER was considered to be effective. Pathological curability was categorized into en bloc resection, negative margins, and negative lymphovascular invasion: differentiated-type, pT1a, ulcer negative, ≤2 cm (Category A1); differentiated-type, pT1a, ulcer negative, >2 cm or ulcer positive, ≤3 cm (Category A2); undifferentiated-type, pT1a, ulcer negative, ≤2 cm (Category A3); differentiated-type, pT1b (SM1), ≤3 cm (Category B); or noncurative resections (Category C)., Results: Overall, the 5-year OS was 89.0% (95% CI, 88.3%-89.6%). In a multivariate analysis, no significant differences were observed when the hazard ratio of Categories A2, A3, and B were compared with that of A1. In all the pathological curability categories, the lower limit of the 95% CI for the 5-year OS exceeded the threshold 5-year OS., Conclusion: ER can be recommended as a standard treatment for patients with EGCs fulfilling Category A2, A3, and B, as well as A1 (UMIN Clinical Trial Registry, UMIN000005871)., (Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.)