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ABSTRACT: BACKGROUND & AIMS: Bleeding from esopahageal and gastric varices is a fatal event in patients with liver cirrhosis and portal hypertension. However, the effects of Helicobacter pylori (H. pylori) infection on esophagogastric variceal bleeding are not known. The present study was aimed to elucidate the role of H. pylori infection in esophagogastric variceal bleeding. METHODS: The subjects were 196 cirrhotic patients who were admitted to the Kurume University Hospital to treat their esophagogastric varices consisted of 95 with acute bleeding and 101 with non-bleeding but high risk of bleeding. For the diagnosis of H. pylori infection, a (13) C-urea breath test was used, and serum pepsinogen (PG) I and II levels and the PG I/II ratio were also measured. RESULTS: Esophagogastric variceal bleeding was seen in 34.9% (n=30) of the H. pylori infected patients (n=86) and in 59.1% (n=65) of the non-infected patients (n=110) (p<0.000 7). There was no significant difference in the infection rate between the bleeding sites of the esophagus and the stomach. The serum PG I and II levels and the PG I/II ratio were 65.6 ng/dL, 14.7 ng/dL, and 4.4, respectively, for the bleeding patients (n=95), and 43.7 ng/dL, 17.7 ng/dL, and 3.1 for the non-bleeding patients (n=10(1) . Thus, the non-bleeding patients had significantly higher rate of H. pylori infection and lower acid secretion than bleeding patients(0.00(1) . In addition, multivariate logistic regression analysis showed a significant negative association between H. pylori infection and esophagogastric variceal bleeding. CONCLUSIONS: These results suggest that H. pylori infection has a protective effect against esophagogastric variceal bleeding through the induction of gastric mucosal atrophy and concomitant hypoacidity.
Journal of Gastroenterology and Hepatology 04/2013; · 2.87 Impact Factor
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Digestive Endoscopy 05/2012; 24(3):192. · 1.19 Impact Factor
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ABSTRACT: Recently, endoscopic ultrasonography (EUS) has been used for the diagnosis of chronic pancreatitis (CP); however, EUS diagnosis of autoimmune pancreatitis (AIP) varies among different researchers. We investigated EUS findings in AIP and retrospectively analyzed them before and after steroid therapy.
The subjects were 32 patients with AIP and the EUS images of the pancreatic parenchyma were evaluated with reference to the Sahai criteria. Patients' background factors detected by EUS were analyzed statistically. Peroral steroid was given to 23 of the 32 patients. EUS was also performed 2 weeks after the initiation of therapy in 14 of the 23 patients, and the changes in EUS were investigated. Microscope images were compared with EUS images in one patient who underwent surgical resection.
EUS results included hyperechoic strands in 26 (81.3%) and lobularity in 17 (53.1%) patients. The patients' background factors included the presence of splenic and/or portal vein occlusion or narrowing around the pancreas in patients who had neither hyperechoic strands nor lobularity (p = 0.002, p = 0.004). The numbers of EUS findings before versus after steroid therapy were 11 versus 5 for hyperechoic strands and 7 versus 2 for lobularity. Microscope images showed the coexistence of relatively well-maintained lobular structures of pancreatic acini and almost complete loss of such structures.
EUS findings in AIP were similar to those in early-stage CP, and hyperechoic strands and lobularity seem to suggest a condition under which the histology of lobular structures of the pancreatic acini is relatively well-maintained. EUS results had improved within about 2 weeks of steroid therapy.
Journal of hepato-biliary-pancreatic sciences. 06/2011; 19(3):266-73.
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Yoshinobu Okabe,
Kotaro Kuwaki,
Hiroshi Kawano,
Ryohei Kaji,
Gen Sugiyama,
Yusuke Ishida,
Makiko Yasumoto,
Yoshiki Naito, Atsushi Toyonaga,
Osamu Tsuruta,
Michio Sata
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ABSTRACT: A 75-year-old man who underwent choledochojejunostomy for gallstones 30 years ago was hospitalized for general malaise. Abdominal computed tomography revealed marked dilation of the intrahepatic bile duct in the right lobe and an image of a hypervascular tumor. Endoscopic retrograde cholangiography using double-balloon enteroscopy (DBE) showed a filling defect that was localized to the right hepatic bile duct. Furthermore, the scope was able to readily pass through the anastomosed site of the choledochojejunostomy and, therefore, we observed the interior of the bile duct using the same scope. We obtained an image showing a whitish, papillary-like tumor, and a biopsy of the tumor rendered the pathology of intraductal papillary mucinous carcinoma. Direct cholangioscopy using DBE is a useful diagnostic tool, particularly in patients with a past history of choledochojejunostomy.
Digestive Endoscopy 10/2010; 22(4):319-21. · 1.19 Impact Factor
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ABSTRACT: Aim: The Clinical Research Committee of the Japan Society for Portal Hypertension has conducted a nationwide questionnaire survey to clarify the current status of ectopic varices in Japan. Methods: A total of 173 cases of ectopic varices were collected. Results: Duodenal varices were found in 57 cases, and most of them were located in the descending to transverse parts. There were 11 cases of small intestinal varices and 6 cases of colonic varices, whereas 77 patients had rectal varices, accounting for the greatest proportion (44.5%). Other sites of varices were the biliary tract, anastomotic sites, the stoma, and the diaphragm. Liver cirrhosis was the most frequent diseases (80.3%) underlying ectopic varices. It was noted that patients with rectal varices frequently had a history of esophageal varices (94.8%) and received endoscopic treatment (87.0%). The treatments for ectopic varices were as an emergency in 46.5%, elective in 35.4% and prophylactic in 18.2%. In emergency cases, endoscopic therapy was most frequent (67.4%), followed by interventional radiology (IVR; 15.2%), and endoscopy-IVR combination (6.5%). Elective treatment was performed by endoscopy in 34.3%, IVR in 28.6%, combined endoscopy-IVR in 5.7%, and surgical operation in 25.7%. The prophylactic treatment was endoscopic in 50.0%, IVR in 33.3%, combined treatments in 11.1%, and prophylactic surgery in none. The change of ectopic varices after treatment was disappearance in 54.9%, remnant in 35.4% and recurrence in 9.7%. The rate of disappearance was significantly lower in rectal varices (40.8%) than in duodenal varices (73.4%). The patient outcome did not differ among the various sites of the lesion. Conslusions: Current status of ectopic varices in Japan has been clarified by a nationwide questionnaire survey. The authors expect that the pathophysiology of ectopic varices will be further elucidated, and that improved diagnostic modalities and treatment methods are established in the future.
Hepatology Research 08/2010; 40(8):763-76. · 2.20 Impact Factor
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ABSTRACT: It is well known that a large portosystemic shunt develops during portal hypertension. In this study, we studied the long-term effects of a large splenorenal shunt (SRS) on liver function and survival.
The subjects were divided into three groups: an SRS (-) group consisting of cirrhotic patients without SRS; an SRS (+) group consisting of patients with gastric fundal varices and SRS; and a balloon-occluded retrograde transvenous obliteration (B-RTO) group with a completely obliterated SRS by B-RTO. We compared the following among these groups: the total bilirubin levels, serum albumin levels, prothrombin times, changes in Child-Pugh scores, and survival rates.
After a 3-year follow-up period the Child-Pugh scores showed significant differences among the SRS (+), SRS (-), and B-RTO groups. The score worsened for the SRS (+) group. The cumulative survival rates were significantly different between the SRS (+) and SRS (-) groups and between the SRS (+) and B-RTO groups. The vital prognosis worsened for the SRS (+) group.
The presence of a large splenorenal shunt (portosystemic shunt) was indicated to lower liver function and vital prognosis. B-RTO, which completely obliterates large splenorenal shunts, inhibited the lowering of hepatic functional reserve and the worsening of vital prognosis, indicating a protective role. Liver pathology and the presence of a large portosystemic shunt each separately result in progressive liver dysfunction and worsen the survival rate. We found that such a pathological condition had occurred due to a large portosystemic shunt, and it should be called 'portosystemic shunt syndrome.'
Journal of Gastroenterology and Hepatology 06/2010; 25(6):1129-35. · 2.87 Impact Factor
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Ryohei Kaji,
Yoshinobu Okabe,
Yusuke Ishida,
Hidetoshi Takedatsu,
Akihiko Kawahara,
Hajime Aino,
Yosuke Morimitsu,
Ryuichiro Maekawa, Atsushi Toyonaga,
Osamu Tsuruta,
Michio Sata
Gastrointestinal endoscopy 10/2009; 71(2):420-2. · 6.71 Impact Factor
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ABSTRACT: Proximally migrated biliary plastic stent and migrated stent in the pancreatic pseudocyst are relatively rare complications. A migrated stent causes poor drainage conditions, which leads to secondary complications such as infection, abscess, perforation and, moreover, becomes a foreign object in the body, and retrieval or re-stenting is therefore necessary. The retrieval of a migrated stent includes surgical, percutaneous and endoscopic approaches, and the most non-invasive method is endoscopic retrieval. However, because very few devices are exclusively designed for retrieval, the current situation is that the available devices are used while taking advantage of various ideas and techniques. From previously reported cases and our experiences of such cases, we herein describe the methods of endoscopic retrieval for stents that have migrated into a bile duct or pancreatic pseudocysts.
Digestive Endoscopy 02/2009; 21(1):1-7. · 1.19 Impact Factor
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Fumihiko Saito,
Yoshinobu Okabe,
Hideya Suga,
Toru Watanabe,
Teruko Arinaga,
Yoshiki Naito,
Shinji Uchida,
Toru Hisaka, Atsushi Toyonaga,
Masamichi Kojiro,
Hisafumi Kinoshita,
Osamu Tsuruta,
Michio Sata
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ABSTRACT: A 68-year-old man was referred to our hospital because of eosinophilia in peripheral blood and pancreatic tumor on abdominal US. He was accustomed to eating the raw flesh of wild boar and keeping wild boar, and under medical treatment for Diabetes. Pancreatic tumor was diagnosed to the pancreatic ductal cancer by the imaging examination and endoscopic transpapillary brushing cytology for pancreatic duct. The diagnosis of hepatic eosinophilic granuloma was done by aspiration biopsy for hepatic multiple small nodules. Because of the strong positive finding for nematose in the assay of multi dot-ELISA for parasite, hepatic eosinophilic granuloma caused by visceral larva migrans was accidentally complicated by pancreatic cancer, and operation for the pancreatic cancer was done. To bear this disease in mind and to research his life history, is important to diagnose hepatic multiple nodules with eosinophilia.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 11/2008; 105(10):1509-14.
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ABSTRACT: The effects of vaso-active agents on hepatic function and splanchnic oxygenation were studied in 17 patients with cirrhosis and portal hypertension. Eight patients received vasopressin (0.3 iu/min) and nine patients received nitroglycerin (50 μg/min). Both drugs caused a significant reduction in the portal venous pressure gradient. Vasopressin infusion significantly decreased intrinsic clearance of indocyanine green (-23%, P<0.01). This may be due to a decreased hepatic perfusion (-28%, P<0.01) and portal venous oxygenation (-15% in portal venous oxygen tension, P<0.05). In contrast, no changes in hepatic perfusion and portal venous oxygenation were observed after nitroglycerin infusion. Nitroglycerin did not decrease intrinsic clearance of indocyanine green. These results suggest that vasodilators, rather than vasoconstrictors, might be welcome in the treatment of patients with cirrhosis and portal hypertension.
Journal of Gastroenterology and Hepatology 03/2008; 7(2):148 - 153. · 2.87 Impact Factor
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Hideo IKEDA,
Makoto KOHAKURA,
Tomoaki MINETOMA,
Nobuhiro IKEDA,
Shinzo KAWAGUCHI,
Yutaka IMAMURA,
Yuji ITO,
Terufumi SAKAI,
Koichi IDE,
Michiko TOMOYOSE,
Osamu TSURUTA, Atsushi TOYONAGA,
Kyuichi TANIKAWA
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ABSTRACT: Churg-Strauss syndrome (CSS), a relatively rare disorder which is associated with serious complications, has a highly variable course and several possible manifestations. We present the case of a 35-year-old woman with a history of bronchial asthma, admitted for evaluation of lower abdominal pain and melena, whose clinical course had certain features in common with CSS. On admission, the white blood cell count was 45,300/mm3 with 65% eosinophils, and the serum immunoglobulin E (5,300 u/ml) level was remarkably elevated. At colonoscopy, there were shallow ulcers, irregular in shape, throughout the large intestine. Abdominal pain and melena were relieved by oral administration of prednisolone. Most previously reported cases have not been recognized as having colonic involvement until surgery or autopsy. In only a few reports of CSS and related disorders were colonoscopic examination findings described.
Digestive Endoscopy 12/2007; 9(2):147 - 152. · 1.19 Impact Factor
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Hideo IKEDA, Atsushi TOYONAGA,
Ei SASAKI,
Hideya SUGA,
Hiroshi KAWANO,
Mitsutake FUJITA,
Shinichi KUBOYAMA,
Kazuhiro FUJISAKI,
Shigeki BAN,
Keiichi MITSUYAMA,
Osamu TSURUTA,
Michiko TOMOYOSE,
Kyuichi TANIKAWA,
Naiki SOMEYA
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ABSTRACT: We report a case of pneumatosis cystoides coii associated with Sjogren's syndrome. This 53-year-old woman initially developed constipation and had bloody stools while she was taking prednisolone 5 mg daily for Sjogren's syndrome. Plain abdominal X-ray revealed a gaseous pattern that resembled a bunch of grapes in the left abdomen. Endoscopic examination of the large intestine revealed numerous hemispheric cystic protrusions in the sigmoid colon and at the splenic flexure of the colon. Pneumatosis cystoides coli was thus diagnosed. Treatment included oxygen inhalation, 5 L/min for 5 hours/day. The X-ray image indicating the collection of gas cleared 17 days after starting treatment. This disorder may merit consideration in the differential diagnosis of intestinal disorders in patients with collagen disease.
Digestive Endoscopy 08/2007; 8(4):302 - 305. · 1.19 Impact Factor
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Tadashi IWAO, Atsushi TOYONAGA,
Johji TANAKA,
Fumihiko YAMASHITA,
Akira IRIE,
Hiroshi HARADA,
Keiichi MITSUYAMA,
Michihiro SUMINO,
Kohsuke TAKAGI,
Ei SASAKI,
Kyuichi TANIKAWA,
Yasuhiro SHIMOTSUURA,
Kohichi IDE
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ABSTRACT: During a 5-year period from 1984 through 1988, an emergency endoscopy was performed for an upper digestive tract hemorrhage in 283 consecutive patients with 290 lesions. Of these, 54 patients were diagnosed as having hemorrhagic gastritis on the basis of the endoscopic findings and were employed as the subjects of the present study. They were classified on the basis of the presence/absence of liver cirrhosis into two groups, i. e. the cirrhosis group (C-group) and non-cirrhosis group (NC-group), and the two groups were comparatively studied.The incidence of hemorrhagic gastritis in hemorrhagic sources of the upper digestive tract was higher in the C-group than in the NC-group, and it was seen in the gastric body most frequently. In addition, no clear causes for hemorrhagic gastritis could be identified in many of the cases in the C-group. These clinical findings were thought to indicate that, in patients with liver cirrhosis, the gastric mucosa itself, especially of the gastric body, is in an impending state of mucosal hemorrhage. A hemorrhage was the major cause of death in the C-group.In patients with liver cirrhosis, the incidence of hemorrhagic gastritis had no correlation with the grade of esophageal varices, but was high in patients with severe liver cirrhosis. Thus, patients with severe liver cirrhosis were considered to be a high risk group of hemorrhagic gastritis.
Digestive Endoscopy 08/2007; 2(1):28 - 39. · 1.19 Impact Factor
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Tadashi IWAO, Atsushi TOYONAGA,
Michihiro SUMINO,
Kohsuke TAKAGI,
Kazuhiko OHO,
Munenori SAKAKI,
Motoki IKEGAMI,
Kazunori OHKUBO,
Rintaroh INOUE,
Ei SASAKI,
Kyuichi TANIKAWA,
Masatoshi NISHIZONO
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ABSTRACT: We studied the relationships between portal pressure measured using the portal venous pressure gradient, the development of gastroesophageal varices, and the risk of variceal bleeding in 56 patients with cirrhosis. Portal pressure was higher in patients with varices than in those without (P>0.01), and 11 mmHg was the lowest portal pressure measured in the patients with varices. The size of the varices was not associated with the portal pressure. There was no difference in the value of portal pressure measurements for the patients with variceal bleeding and those without and there was no linear-relationship between the degree of portal hypertension and the rate of variceal bleeding. 12 mmHg was the lowest portal pressure measured in the patients with variceal bleeding. The size of the varices was related to the rate of variceal bleeding (P>0.05). We conclude that (a) a portal pressure of 11 mmHg is necessary for the formation of varices, (b) 12 mmHg of portal pressure is necessary for variceal bleeding to occur but the degree of portal hypertension has no predictive value for the risk of variceal bleeding, and (c) the size of the varices does not depend on the degree of portal hypertension but is associated with the risk of variceal bleeding.
Digestive Endoscopy 08/2007; 3(4):485 - 490. · 1.19 Impact Factor
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Hiroyuki Koga,
Tatsuya Ide,
Kazuhiko Oho,
Reiichiro Kuwahara,
Teruko Hino,
Kei Ogata,
Akiko Hisamochi,
Kazuo Tanaka,
Ryukichi Kumashiro, Atsushi Toyonaga,
Michio Sata
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ABSTRACT: Aim: Many studies have reported the therapeutic effects of lamivudine on cirrhotic patients with hepatitis B; however, no study has investigated the morphological changes of esophageal varices after lamivudine treatment. Method: The morphological changes of esophageal varices in patients with cirrhosis were retrospectively compared between 12 patients treated with lamivudine and six historical untreated patients. Results: In the treated group, the HBV DNA and hyaluronic acid (HA) levels in the serum were significantly lower than those in the untreated group (P = 0.013 and P = 0.009, respectively) at the end of follow-up, with a significant improvement in the Child-Pugh-Turcotte score (P = 0.022). In the treated group, the disappearance or reduction of esophageal varices was observed in six (50%) of the 12 patients. In three (25%) of the 12 patients, esophageal varices worsened. In the remaining three patients (25%), there were no changes in esophageal varices. In the untreated group, all patients showed the worsening of esophageal varices during the follow-up period, with a significant difference between this group and the treated group (P = 0.009). The serum HA level decreased in the nine treated patients without worsening of esophageal varices. However, in the three patients with worsening, the HA level significantly increased. Conclusion: Lamivudine treatment for patients with cirrhosis improves not only liver function but also esophageal varices.
Hepatology Research 08/2007; 37(7):503-9. · 2.20 Impact Factor
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Hideya Suga,
Osamu Tsuruta,
Yoshinobu Okabe,
Fumihiko Saito,
Yoshiki Naito,
Rumiko Kutumi,
Masaharu Shinagawa,
Masashi Uchida,
Hisafumi Kinoshita,
Masamichi Kojiro, Atsushi Toyonaga,
Michio Sata
Pancreas 06/2007; 35(1):84. · 2.39 Impact Factor
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ABSTRACT: Although various therapies have been tried to improve advanced nonresectable pancreatic cancer, a sufficient consensus has not yet been obtained about the treatment. We have performed arterial infusion chemotherapy for pancreatic cancer in order to maintain QOL. The response rate was 17.3%, the mean survival time 282.1+/-204.7 days, median survival time 243.0+/-84.7 days, and many patients were continuously treated on an outpatient basis. It is thus expected that survival time and maintenance of QOL can be extended by self-sustaining arterial infusion chemotherapy.
Gan to kagaku ryoho. Cancer & chemotherapy 10/2006; 33(9):1226-30.
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ABSTRACT: Transpapillary biliary drainage has developed as an applied technique of endoscopic retrograde cholangiopancreatography and spread as a routine procedure. Particularly, endoscopic biliary drainage (EBD), which is characterized by physiologic nature, mild invasiveness, and no restriction of life, is a reasonable and efficient method for temporary or permanent biliary drainage. Also, improvements in the stent material, increases in the stent diameter, and advent of metallic stents have solved many problems with EBD. However, despite the improvements in various imaging techniques and development of surgical procedures and multidisciplinary treatment, many old as well as new problems such as the selection of the drainage method, stenting method, stent patency rate, stent material, and concomitant treatments still remain. For a more effective clinical use of EBD, the selection of the optimal drainage method and stent for individual patients and the development of stents and basic clinical research from the viewpoints of concomitant treatments are necessary.
Digestive Endoscopy 07/2006; 18(s1):S112 - S114. · 1.19 Impact Factor
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ABSTRACT: Since Jun-N-terminal kinase participates in intracellular signaling cascades resulting in inflammatory responses, inhibiting this pathway may represent a new treatment for inflammatory bowel disease including ulcerative colitis and Crohn's disease. However, the functional significance of the activation of this kinase in inflammatory bowel disease remains unclear. We investigated whether Jun-N-terminal kinase activation is increased in inflammatory bowel disease and analyzed the effects of SP600125, which decreases inflammatory cytokine synthesis by inhibiting the phosphorylation of this kinase. Phosphorylation of the kinase was examined in affected human colon using an enzyme-linked immunosorbent assay and immunohistochemistry. The effect of SP600125 on cytokine production was examined in cultures of patients' leukocytes and colonic tissue. Finally, rats received injection of SP600125 (30 mg/kg, s.c.) or vehicle twice daily 2 h before the induction of colitis with dextran sulfate sodium. SP600125 effects were determined observationally and histologically. Colonic tissue contained increased phosphorylated kinase in patients with inflammatory bowel disease with expression localized to the nucleus of epithelial and lamina propria mononuclear cells in lesions. Culturing mononuclear cells or colonic tissue with SP600125 down-regulated inflammatory cytokine production. Prophylactic treatment with SP600125 significantly reduced clinical and pathological scores in dextran sulfate sodium-treated rats. This first demonstration of the pathogenetic role of Jun-N-terminal kinase in the development of intestinal inflammation suggests that inhibiting its phosphorylation could benefit patients with inflammatory bowel disease.
International Journal of Molecular Medicine 04/2006; 17(3):449-55. · 1.98 Impact Factor
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Yoshinobu Okabe,
Osamu Tsuruta,
Yuki Wada,
Kazuhiko Wada,
Hideya Suga,
Maisa Kudoh,
Ryuichi Kawahara,
Takatoshi Kodama,
Hisafumi Kinoshita, Atsushi Toyonaga,
Michio Sata
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ABSTRACT: The patient was a 45-year-old man with a history of heavy drinking. A pseudocyst about 30 mm in diameter was found in the head of his pancreas. About four weeks later an upper abdominal mass, abdominal pain and obstructive jaundice were confirmed. Abdominal CT revealed that the cyst had increased in size to about 60 mm, compressing the lower common bile duct and the surrounding digestive tract. Therefore endoscopic ultrasonography-guided cystogastrostomy following percutaneous transhepatic biliary drainage (PTBD) was performed. Postoperatively, the cyst quickly decreased in size and jaundice improved. Because of persistent common bile duct stenosis, an endoscopic retrograde biliary stent was implanted. There has been no recurrence at ten months after the endoscopic therapy. While invasive surgery is generally employed in the treatment of pancreatic pseudocyst complicated by obstructive jaundice, EUS-guided cystogastrostomy appears to be a useful procedure, particularly when considering the relatively minor degree of surgical invasion.
The Kurume Medical Journal 02/2006; 53(3-4):89-94.
