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Naoki Hosoe,
Katsuyoshi Matsuoka,
Makoto Naganuma,
Yosuke Ida,
Yuka Ishibashi,
Kayoko Kimura,
Kazuaki Yoneno,
Shingo Usui,
Kazuhiro Kashiwagi,
Tadakazu Hisamatsu, Nagamu Inoue,
Takanori Kanai,
Hiroyuki Imaeda,
Haruhiko Ogata,
Toshifumi Hibi
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ABSTRACT: BACKGROUND AND AIM: Colon capsule endoscopy has already been used for colon visualization and detection of polyps but its applicability to inflammatory bowel disease is still unconfirmed. To assess the feasibility of evaluating the severity of mucosal inflammation in patients with ulcerative colitis (UC) using a second generation colon capsule endoscope (CCE-2). METHODS: Forty patients with histological confirmed diagnosis of UC were enrolled. Low volume (2L) polyethylene glycol solution (PEG) with prokinetics (mosapride citrate and metoclopramide) regimen were used for the bowel preparation. In Phase 1, consisting of 10 patients, to confirm appropriate CCE-2 bowel preparation for UC. In Phase 2, consisting of 30 patients, CCE-2 was performed with a fixed bowel preparation regimen. CCE-2 findings were recorded for 8 hours starting from capsule ingestion and conventional colonoscopy was subsequently performed on the same day. CCE-2 procedure completion rate and the colon cleansing level with a 4-point grading scale (poor, fair, good, and excellent) were evaluated in Phase 2. Correlations between Matts endoscopic scores as judged by CCE-2 and conventional colonoscopy were calculated. RESULTS: CCE-2 procedure was completed within 8 hours in 69% of the patients. The proportion of patients with good or excellent cleansing level was below 50%. However, Matts endoscopic scores determined by CCE-2 showed a strong correlation with scores obtained by conventional colonoscopy (average ρ = 0.797). CONCLUSIONS: Though modifications in bowel preparation are needed, CCE-2 might be feasible for assessing the severity of mucosal inflammation in patients with UC.
Journal of Gastroenterology and Hepatology 03/2013; · 2.87 Impact Factor
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Journal of Gastroenterology 08/2012; · 4.16 Impact Factor
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ABSTRACT: The effect of granulocyte and monocyte adsorption apheresis (GMA) on prevention of relapse of ulcerative colitis (UC) is not clear. This was a pilot open-labeled, prospective, randomized, unblinded study to compare the tolerability and efficacy of intermittent GMA (once every 2 weeks) with mercaptopurine to maintain remission of UC. Twenty-one patients with UC, who had achieved remission by induction therapies were randomly assigned to receive either intermittent GMA (N = 10) or oral mercaptopurine (0.5 mg/kg per day; N = 11). The study period was 24 months. The rate of the patients maintaining remission and the incidences of adverse effects were compared between the two groups. At 24 months, seven of 10 patients (70.0%) on intermittent GMA and seven of 11 patients (63.6%, P = 1.00) on oral mercaptopurine were still in remission. Three patients relapsed in each group. One patient taking mercaptopurine, but none receiving intermittent GMA, dropped out because of adverse effects. Intermittent therapy with GMA was well tolerated and a substantial proportion of patients maintained remission. Intermittent GMA therapy in maintaining remission of UC merits further investigation.
Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 06/2012; 16(3):213-8. · 1.39 Impact Factor
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ABSTRACT: Background and Aim: In Japan, patient acceptance of bowel preparation methods before colonoscopy remains unknown. This study was conducted to evaluate the patient acceptance of sodium phosphate (NaP) tablets and polyethylene glycol solution (PEG) with sodium picosulfate. Methods: One hundred patients were randomized into one of the following two groups: the NaP tablet first-use group or the PEG with sodium picosulfate first-use group in a crossover design trial. Patient acceptance and incidence of adverse events were evaluated using a questionnaire. Colon-cleansing effectiveness was also evaluated. Results: Patients' overall impressions of the preparations were significantly different between the NaP tablet (77.9%, 67/86) and PEG with sodium picosulfate (60.5%, 52/86; P = 0.001). Nausea incidence as an adverse event was significantly different between the two regimens (P = 0.03). Colon-cleansing effectiveness was not significantly different between the two regimens. Conclusions: The results of this crossover study showed that patient acceptance was similar to those previously reported in a parallel-group comparison. In Japanese patients, preference for and acceptance of NaP tablets was significantly higher than that for PEG with sodium picosulfate solution.
Journal of Gastroenterology and Hepatology 05/2012; 27(10):1617-22. · 2.87 Impact Factor
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Jun Miyoshi,
Tomoharu Yajima,
Susumu Okamoto,
Katsuyoshi Matsuoka, Nagamu Inoue,
Tadakazu Hisamatsu,
Katsuyoshi Shimamura,
Atsushi Nakazawa,
Takanori Kanai,
Haruhiko Ogata,
Yasushi Iwao,
Makio Mukai,
Toshifumi Hibi
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ABSTRACT: BackgroundHost–intestinal microbial interaction plays an important role in the pathogenesis of inflammatory bowel diseases (IBDs). The
surface molecules of the intestinal epithelium act as receptors for bacterial adhesion and regulate the intestinal bacteria.
Some known receptors are the mucosal blood type antigens, which are regulated by the fucosyltransferase2 (FUT2) gene, and individuals who express these antigens in the gastrointestinal tract are called secretors. Recent research has
revealed that the FUT2 gene is associated with Crohn’s disease (CD) in western populations.
MethodsTo clarify the contribution of mucosal blood type antigens in IBD, we determined the incidence of five previously reported
single-nucleotide polymorphisms of the FUT2 gene in Japanese patients. We also used immunohistochemistry to investigate the antigen expression in mucosal specimens from
IBD patients and animal models.
ResultsGenetic analysis revealed that all of the patients with colonic CD were secretors, whereas the incidence of secretors was
80, 80, 67, and 80%, respectively, for the control, ileocolonic CD, ileal CD, and ulcerative colitis groups (P=0.036). Abnormal expression of blood type antigens was observed only in colonic CD. Interleukin-10−/− mice, but not dextran sulfate sodium colitis mice, had enhanced colonic expression of blood type antigens, and the expression
of these antigens preceded the development of colitis in the interleukin-10−/− mice.
Conclusions
FUT2 secretor status was associated with colonic-type CD. This finding, taken together with the immunohistochemistry data, suggests
that the abnormal expression of blood type antigens in the colon may be a unique and essential factor for colonic CD.
KeywordsColonic Crohn’s disease–
FUT2
–Blood type antigen
Journal of Gastroenterology 04/2012; 46(9):1056-1063. · 4.16 Impact Factor
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ABSTRACT: Although the prevalence of inflammatory bowel disease (IBD) is reported to have reached a plateau in Western countries, it is increasing in Asia. The etiology of IBD is still under investigation. We performed an epidemiological study to clarify the characteristics of IBD in Japan, focusing on patients' family history.
We obtained clinical data on ulcerative colitis (UC) (46,114 cases) and Crohn's disease (CD) (11,305 cases) in 2007 from an electronic database maintained under the Japanese Ministry of Health, Labour and Welfare's nationwide registry system, and analyzed the differences in disease characteristics between patients with IBD who had a family history of the disease and those who did not.
A total of 2.7% of the patients with UC and 2.6% of those with CD had a family history. The present age and age at disease onset were lower among the patients with UC who had a family history than among those without (present age: p < 0.001; age at disease onset: p < 0.001; Mann-Whitney U-test), but no similar trend was observed in the patients with CD. Disease severity was worse among both the UC and CD patients with a family history. The clinical course of patients with UC was not affected by family history. Levels of independence in daily life were associated with family history among CD patients, whereas age was associated with levels of independence in daily life among UC patients.
Disease characteristics of IBD vary in some aspects according to the presence or absence of a family history.
Journal of Gastroenterology 03/2012; 47(9):961-8. · 4.16 Impact Factor
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Nippon rinsho. Japanese journal of clinical medicine 02/2012; 70 Suppl 1:209-17.
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ABSTRACT: Behçet's disease is a chronic relapsing disease with multiple organ system involvement, including the gastrointestinal tract, which is known as intestinal Behçet's disease. Intestinal Behçet's disease is often resistant to empirical treatments such as 5-aminosalicylic acid, immunomodulators and steroids and often causes a perforation, requiring surgical resection. Therefore, intestinal lesions are considered to be a poor prognostic factor in Behçet's disease. Recently, several reports have demonstrated the efficacy of anti-TNFα monoclonal antibodies, such as infliximab, against intestinal Behçet's disease, however, it remains unknown whether anti-TNFα therapy can improve the prognosis of patients with intestinal Behçet's disease. We herein report the case of an adult female patient with intestinal Behçet's disease who responded well to the induction therapy with infliximab, and has been maintained in remission by scheduled administration of infliximab. Her C-reactive protein level has been sustained at a negative level, and endoscopic findings revealed complete mucosal healing. Therefore, infliximab may have the potential to induce "sustained deep remission" in patients with intestinal Behçet's disease.
Internal Medicine 01/2012; 51(16):2125-9. · 0.94 Impact Factor
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Tadakazu Hisamatsu,
Susumu Okamoto,
Masaki Hashimoto,
Takahiko Muramatsu,
Ayatoshi Andou,
Michihide Uo,
Mina T Kitazume,
Katsuyoshi Matsuoka,
Tomoharu Yajima, Nagamu Inoue,
Takanori Kanai,
Haruhiko Ogata,
Yasushi Iwao,
Minoru Yamakado,
Ryosei Sakai,
Nobukazu Ono,
Toshihiko Ando,
Manabu Suzuki,
Toshifumi Hibi
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ABSTRACT: Inflammatory bowel disease (IBD) is a chronic intestinal disorder that is associated with a limited number of clinical biomarkers. In order to facilitate the diagnosis of IBD and assess its disease activity, we investigated the potential of novel multivariate indexes using statistical modeling of plasma amino acid concentrations (aminogram).
We measured fasting plasma aminograms in 387 IBD patients (Crohn's disease (CD), n = 165; ulcerative colitis (UC), n = 222) and 210 healthy controls. Based on Fisher linear classifiers, multivariate indexes were developed from the aminogram in discovery samples (CD, n = 102; UC, n = 102; age and sex-matched healthy controls, n = 102) and internally validated. The indexes were used to discriminate between CD or UC patients and healthy controls, as well as between patients with active disease and those in remission. We assessed index performances using the area under the curve of the receiver operating characteristic (ROC AUC). We observed significant alterations to the plasma aminogram, including histidine and tryptophan. The multivariate indexes established from plasma aminograms were able to distinguish CD or UC patients from healthy controls with ROC AUCs of 0.940 (95% confidence interval (CI): 0.898-0.983) and 0.894 (95%CI: 0.853-0.935), respectively in validation samples (CD, n = 63; UC, n = 120; healthy controls, n = 108). In addition, other indexes appeared to be a measure of disease activity. These indexes distinguished active CD or UC patients from each remission patients with ROC AUCs of 0.894 (95%CI: 0.853-0.935) and 0.849 (95%CI: 0.770-0.928), and correlated with clinical disease activity indexes for CD (r(s) = 0.592, 95%CI: 0.385-0.742, p<0.001) or UC (r(s) = 0.598, 95%CI: 0.452-0.713, p<0.001), respectively.
In this study, we demonstrated that established multivariate indexes composed of plasma amino acid profiles can serve as novel, non-invasive, objective biomarkers for the diagnosis and monitoring of IBD, providing us with new insights into the pathophysiology of the disease.
PLoS ONE 01/2012; 7(1):e31131. · 4.09 Impact Factor
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ABSTRACT: Routine diagnosis of the histopathological activity of ulcerative colitis (UC) requires multiple biopsy samples, and an endocytoscopy system (ECS) provides real-time ultra-magnifying microscopic imaging in vivo.
We have established an ECS score (ECSS) to determine a histopathological activity index of UC. Fifty-five UC patients (mean age 40.7 years; 67% men) were enrolled. A super-magnifying ECS with magnification 450× was used, and sample biopsies were obtained. Matts' histopathological grade was determined, to evaluate disease severity, by two pathologists, with consensus. The ECSS of UC was independently determined by at least two investigators, with consensus. In total, 76 pairs of ECSS and Matts' histopathological grades were independently acquired. To validate the ECSS, inter-observer agreement between three endoscopists, with consensus, and another endoscopist, was calculated as the kappa value. We also evaluated the correlation between the ECSS and Matts' histopathological grade, and between the conventional Matts' endoscopic grade and Matts' histopathological grade.
The ECSS of UC intestinal mucosa, i.e., the sum of the indices for shape (0-3) and distance between crypts (0-2), and the visibility of superficial microvessels (0-1), showed a strong correlation with Matts' histopathological grades (ρ = 0.713, P < 0.001); as well, there was a strong correlation between the conventional Matts' endoscopic grade and Matts' histopathological grade (ρ = 0.694, P < 0.001). Furthermore, the ECSS showed high reproducibility (κ = 0.79, 95% confidence interval [CI] 0.71-0.87).
Our novel ECSS has good predictive value for the histopathological activity of UC.
Journal of Gastroenterology 07/2011; 46(10):1197-202. · 4.16 Impact Factor
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Taku Kobayashi,
Makoto Naganuma,
Susumu Okamoto,
Tadakazu Hisamatsu, Nagamu Inoue,
Hitoshi Ichikawa,
Tetsuro Takayama,
Riko Saito,
Tomohisa Sujino,
Haruhiko Ogata,
Yasushi Iwao,
Toshifumi Hibi
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ABSTRACT: Intravenous (IV) cyclosporine A (CSA) is one of the treatments of choice for patients with steroid-refractory severe ulcerative colitis (UC). In this study, we evaluated the overall experience with CSA treatment in UC patients, from their initial response to long-term prognosis.
The medical records of 72 patients admitted to our hospital with a severe UC flare-up and treated with IV CSA between November 1996 and October 2008 were reviewed retrospectively. The initial response to CSA was assessed using a clinical activity index, and colectomy was assigned as the endpoint for the long-term prognosis.
Overall, 53 of 72 (73.6%) patients responded initially to CSA. We could not determine any specific parameters that predicted an initial response. A life-table analysis for all patients revealed that 54.4% of patients required a colectomy within 11 years. The long-term risk of surgery was associated with a shorter disease duration, history of adverse reactions against medications and lack of immunomodulator use. In addition, endoscopic improvement at day 14 was associated with colectomy at 1 year, but not with the long-term prognosis.
Although CSA can exert high initial efficacy for severe attacks of UC, >50% of patients who relapse require a colectomy. Specifically, mucosal healing evaluated by endoscopy was associated with the 1-year colectomy rate. In contrast, a history of adverse drug reactions was correlated with the long-term colectomy rate. Therefore, we propose that treatment of severe UC with CSA requires consideration of both initial remission and long-term maintenance as management goals.
Journal of Gastroenterology 11/2010; 45(11):1129-37. · 4.16 Impact Factor
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Naoki Hosoe,
Taku Kobayashi,
Takanori Kanai,
Rieko Bessho,
Tetsuro Takayama, Nagamu Inoue,
Hiroyuki Imaeda,
Yasushi Iwao,
Seiki Kobayashi,
Makio Mukai,
Haruhiko Ogata,
Toshifumi Hibi
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ABSTRACT: The endocytoscopy system (ECS) is a new method to provide real-time super-magnifying microscopic imaging in vivo. Routine diagnosis of amebic colitis requires multiple tests that are both time consuming and costly.
To determine the feasibility of ECS to directly detect the amebic parasites in vivo.
Prospective, single-center, pilot study.
Tertiary-care university hospital.
This study involved 5 patients who were suspected to have amebic colitis by conventional colonoscopy in our institute.
A super-magnifying ECS with 450 x magnification.
We compared ECS findings with those of conventional methods-serum antibody tests and histology of colon biopsy specimens.
We successfully visualized the amebic trophozoites in all 5 cases. In contrast, 3 specimens had positive results on serology, and 3 had positive histology results on hematoxylin and eosin staining.
Pilot study with a limited number of patients. Findings were compared only with serology and histology findings.
ECS would be a useful tool for the prompt diagnosis of amebic colitis via the real-time in vivo visualization of amebic trophozoites.
Gastrointestinal endoscopy 09/2010; 72(3):643-6. · 6.71 Impact Factor
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ABSTRACT: Clinical symptoms are the most important factors used by physicians to evaluate the severity and extent of ulcerative colitis (UC). In this context, colonoscopy is also a useful diagnostic tool. We have recently developed an endoscopic activity index (EAI) to assess the severity of UC. Here, we assess the correlations among the EAI, other endoscopic indices, and clinical scores. The usefulness of the EAI for choosing treatment options, such as intravenous corticosteroid or cyclosporine A (CsA), in severe UC patients was also evaluated.
Clinical symptoms and endoscopic finding were evaluated in 396 patients with UC (454 colonoscopies). The EAI was scored using the following six items: ulcer size, ulcer depth, redness, bleeding, edema, and mucus exudates. The patients were also scored using Matts' grade, Rachmilewitz's endoscopic index, and the Lichtiger index.
Our results showed that (1) the EAI scores were closely correlated with those of the Lichtiger index, Matts' grade, and Rachmilewitz's endoscopic index; (2) the EAI scores significantly decreased in patients who responded to treatment, while Matts' grade did not change in some responders treated with intravenous CsA and steroid; (3) patients with a higher EAI (14-16) tended to be refractory to corticosteroid therapy (responders 19%) compared to CsA (77%), while steroid treatment was effective in 58% of patients with EAI scores of 11-13.
The EAI is equivalent to other endoscopic indices and relatively more useful in choosing a treatment for patients with severe UC.
Journal of Gastroenterology 09/2010; 45(9):936-43. · 4.16 Impact Factor
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Yohei Mikami,
Takanori Kanai,
Tomohisa Sujino,
Yuichi Ono,
Atsushi Hayashi,
Akira Okazawa,
Nobuhiko Kamada,
Katsuyoshi Matsuoka,
Tadakazu Hisamatsu,
Susumu Okamoto,
Hiromasa Takaishi, Nagamu Inoue,
Haruhiko Ogata,
Toshifumi Hibi
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ABSTRACT: Th17 cells and Th1 cells coordinate to play a critical role in the formation of inflammatory bowel diseases. To examine how Th17 and Th1 cells are regulated at inflammatory sites, we used Th1-dominant CD4(+)CD45RB(high) T cell-transferred RAG-2(-/-) and Th1/Th17-mixed IL-10(-/-) mice. Interestingly, not only did colitic RAG-2(-/-) mice that were parabiosed with WT mice show significant amelioration of colitis, but amelioration of disease was also observed in those parabiosed with colitic IL-10(-/-) mice. To assess the interference between Th1 and Th17 colitogenic T cells, we co-transferred colitogenic CD4(+) T cells from the lamina propria (LP) of CD4(+)CD45RB(high) T cell-transferred RAG-2(-/-) mice and IL-10(-/-) mice into RAG-2(-/-) mice. Surprisingly, the co-transferred RAG-2(-/-) mice showed a vast cellular infiltration of LP CD4(+) T cells similar to that seen in RAG-2(-/-) mice re-transferred with the cells from colitic RAG-2(-/-) mice alone, but the co-transferred RAG-2(-/-) mice did not have the wasting symptoms, which are also absent in RAG-2(-/-) mice transferred with cells from colitic IL-10(-/-) mice alone. Furthermore, the percentages of Th1 and Th17 cells originating from IL-10(-/-) mice and those of Th1 cells originating from colitic RAG-2(-/-) mice were all significantly decreased in the co-transferred mice as compared with the singly-transferred paired RAG-2(-/-) mice, suggesting that Th1 and Th17 cells are in competition, and that their orchestration results in a merged clinical phenotype of the two types of murine colitis.
European Journal of Immunology 09/2010; 40(9):2409-22. · 5.10 Impact Factor
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Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 06/2010; 107(6):868-75.
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ABSTRACT: Various different clinical indices (CI) and endoscopic indices (El) have been used to evaluate the clinical disease activity of ulcerative colitis (UC). However, no standardized CI or El of UC has been established. The aim of the present study was to determine whether or not any of the CI and/or EI for assessing the disease activity of UC could be established as a standard.
The most frequently used CI and EI were identified from 100 published clinical trials dealing with UC, and representative CI and El were selected. Seventy-four patients were enrolled in this study and their CI and El were assessed prior to treatment and at 2, 4 and 8 weeks after treatment. Furthermore, changes over time and relationships among the indices were analyzed. In this study, the clinical activity index (CAI), the disease activity index (DAI), the Lichtiger index (LI) and the Seo index were selected as the representative CI, and the Baron score and the Rachmilewitz endoscopic index (REI) were selected as the representative EI.
A significant decrease in all the CI and El was observed after treatment, as compared with the baseline values. Moreover, there were positive relationships among the CI and between the CI and El.
Our results demonstrated that all the CI and El examined were almost equally useful for evaluating disease activity in UC patients. Further studies may help to determine which of the indices is the most suitable for use in UC clinical trials.
Digestive Endoscopy 01/2010; 22(1):39-44. · 1.19 Impact Factor
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ABSTRACT: The prevalence of inflammatory bowel diseases is much lower in Asian countries, including Japan, than in Western countries, but it is rapidly increasing. However, no recent reports describe the current prevalence of these diseases in Japan, so we performed a descriptive epidemiological study to remedy this situation and to elucidate various characteristics of inflammatory bowel diseases in this country.
Japan has a nationwide registration system of patients with intractable diseases, including ulcerative colitis and Crohn's disease. To calculate the age-standardized prevalence, we used this registration system to collect patient data, and we obtained detailed population data from the Japanese government's population estimates made in 2003 and 2004 and from the 2005 population census. In addition, information about the characteristics of ulcerative colitis and Crohn's disease patients was collected through the registration system.
The age-standardized prevalence of ulcerative colitis in Japan in 2005 was 63.6 per 100,000 persons, and that of Crohn's disease was 21.2. Patient numbers have been steadily increasing with time. The age distribution was found to differ between the two diseases, with Crohn's disease affecting mainly younger people. In both diseases, more than 50% of the patients were male, and over 80% of the patients were classified as mild to moderate in terms of severity.
The prevalence of inflammatory bowel diseases in Japan is still much lower than in Western countries. Surveillance should be continued, and research to clarify their etiologies in association with the increasing number of patients in Japan is needed.
Journal of Gastroenterology 06/2009; 44(7):659-65. · 4.16 Impact Factor
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ABSTRACT: The demand for percutaneous endoscopic gastrostomy (PEG) has increased because it is safe and a technically easy method, but it has risks of severe complications including death and a high mortality rate within 30 days. At present, we cannot predict survival or the incidence of complications before tube placement in an individual. Earlier studies have used traditional statistical analysis by assuming a linear relationship between clinical features, but most phenomena in the clinical situation are not linearly related.
We predicted the survival and complications before PEG placement in an individual by using artificial neural network (ANN) system, which can assess the nonlinear relationship.
We studied 100 patients who underwent PEG at the Kitasato Medical Institute Hospital from 1997 to 2005. Clinical data and laboratory data were used as input data. Complications related to PEG placement and survival dates were historically and prospectively measured. From the clinical data and laboratory data, we examined the prediction of outcome in individual patients using multiple logistic regression analysis and an ANN.
The correct answer rate of survival by multiple logistic regression analysis was 67.9%. In contrast, using the ANN, we correctly predicted the survival date and aspiration pneumonia in 75 and 89% of patients, respectively. There was a nonlinear relationship among input factors and survival and complications.
We correctly predicted the outcome and complications of individual patients with PEG with a high correct answer rate. Our data show the potential of an ANN as a powerful tool in daily clinical use to individualize treatment ('tailor-made medicine') for PEG and reduce costs.
European journal of gastroenterology & hepatology 06/2009; 21(11):1279-85. · 1.66 Impact Factor
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Naoki Hosoe,
Hiroyuki Imaeda,
Kazuhiro Kashiwagi,
Makoto Naganuma, Nagamu Inoue,
Hidekazu Suzuki,
Kazuhiro Suganuma,
Yosuke Ida,
Hiromasa Nakamizo,
Koichi Aiura,
Haruhiko Ogata,
Yasushi Iwao,
Koichiro Kumai,
Toshifumi Hibi
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ABSTRACT: Endoscopic hemostasis using hemoclips is useful, but there are technical difficulties because the angle of the approach is tangential. A transparent hood facilitates the observation and treatment of these lesions, and a shorter hood provides a wider visible field. Endoscopic hemoclipping of hard lesions with hemoclips of the conventional size does not reliably result in sustained hemostasis because the clips slip. Short clips, however, can be easily clamped on protruded visible vessels without slip. The aim of the present study was to evaluate the efficacy of endoscopic hemostasis with a short transparent hood and short clips.
Subjects were 198 patients with 214 lesions of non-variceal upper gastrointestinal bleeding at Keio University Hospital. We used a video endoscope with a short transparent hood attached to its distal tip and carried out hemostasis using short hemoclips.
The short transparent hood provided a good visual field. If the lesions were in the tangential, the short hood made it possible to observe them in the frontal view and made clip hemostasis much easier. The short clip could be securely clamped against protruded visible vessels. Of 214 lesion, 211 (98.6%) had temporal hemostasis. Rebleeding occurred in 13 of 211 lesions (6.2%), and 205 of 214 lesions (95.8%) had permanent hemostasis. Nine cases were endoscopically difficult.
Endoscopic hemostasis with a short transparent hood and short clips is useful for non-variceal upper gastrointestinal bleeding.
Digestive Endoscopy 05/2009; 21(2):93-6. · 1.19 Impact Factor
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Hiromasa Takaishi,
Takahiro Matsuki,
Atsushi Nakazawa,
Toshihiko Takada,
Shoichi Kado,
Takashi Asahara,
Nobuhiko Kamada,
Atsushi Sakuraba,
Tomoharu Yajima,
Hajime Higuchi, Nagamu Inoue,
Haruhiko Ogata,
Yasushi Iwao,
Koji Nomoto,
Ryuichiro Tanaka,
Toshifumi Hibi
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ABSTRACT: Since genetically engineered animal models of inflammatory bowel disease (IBD) do not develop colitis under germ-free conditions, the intestinal microflora is thought to be one of the most important environmental factors associated with IBD. To understand the involvement of intestinal microflora in the pathogenesis of IBD, we analyzed the constituents of intestinal microflora in IBD. Faecal samples from 73 patients with ulcerative colitis (UC) and 23 patients with Crohn's disease (CD) were analyzed by quantitative PCR using 16S rRNA gene-targeted group-specific primers for Bacteroides fragilis group, Bifidobacterium, Clostridium coccoides groups, Clostridium leptum subgroup, Atopobium cluster, and seven species of Bacteroides. We analyzed the distribution of the predominant microflora by fluorescence in situ hybridization (FISH) using group-specific probes. We also examined the concentration of faecal organic acids produced by intestinal microflora. Contrary to previous reports, we found that the B. fragilis group was significantly decreased in the faeces of patients with IBD. Moreover, B. vulgatus was the predominant microflora in healthy controls and relatively decreased among IBD patients. Most of the microflora adhering to the colonic mucosa surrounding the mucus layer comprised C. coccoides group and Bifidobacterium. B. fragilis group mainly inhabited the faeces, but did not adhere to or invade the mucosa. The concentrations of propionic and butyric acids in the faeces were significantly decreased in patients with IBD. These findings indicate that IBD is not caused by a specific intestinal bacterial cluster or species and that disordered intestinal microflora could be involved in the pathogenesis of IBD.
International journal of medical microbiology: IJMM 08/2008; 298(5-6):463-72. · 2.80 Impact Factor
