Noriaki Manabe

Kawasaki Medical University, Kurasiki, Okayama, Japan

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Publications (156)869.42 Total impact

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    ABSTRACT: General interest in functional gastrointestinal disorders is increasing among Japanese doctors as well as patients. This increase can be attributed to a number of factors, including recent increased interest in quality of life and advances in our understanding of the pathophysiology of gastrointestinal disease. Japan recently became the world's first country to list "functional dyspepsia" as a disease name for national insurance billing purposes. However, recognition and understanding of functional dyspepsia (FD) remain poor, and no standard treatment strategy has yet been established. Accordingly, the Japanese Society of Gastroenterology (JSGE) developed an evidence-based clinical practice guideline for FD, consisting of five sections: concept, definition, and epidemiology; pathophysiology; diagnosis; treatment; and prognosis and complications. This article summarizes the Japanese guideline, with particular focus on the treatment section. Once a patient is diagnosed with FD, the doctor should carefully explain the pathophysiology and benign nature of this condition, establish a good doctor-patient relationship, and then provide advice for daily living (diet and lifestyle modifications, explanations, and reassurance). The proposed pharmacological treatment is divided into two steps: initial treatment including an acid inhibitory drug (H2RA or PPI) or prokinetics, (strong recommendation); second-line treatment including anxiolytics, antidepressants, and Japanese traditional medicine (weak recommendation). H. pylori eradication, strongly recommended with a high evidence level, is positioned separately from other treatment flows. Conditions that do not respond to these treatment regimens are regarded as refractory FD. Patients will be further examined for other organic disorders or will be referred to specialists using other approaches such as psychosomatic treatment.
    Journal of Gastroenterology 01/2015; 50(2). DOI:10.1007/s00535-014-1022-3 · 4.02 Impact Factor
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    ABSTRACT: Background This study aimed to evaluate risk factors for resistance to proton-pump inhibitor (PPI) therapy among patients with reflux esophagitis (RE) and nonerosive reflux disease (NERD) in gastroesophageal reflux disease (GERD) using a standardized questionnaire in Japan: the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG). Methods One hundred fifty-eight patients who underwent upper gastrointestinal endoscopy were enrolled: 87 were diagnosed with RE (mean age: 59.5 ± 15.1 years; male/female: 47/39) and 71 with NERD (mean age 53.0 ± 17.6 years; male/female 22/49). The patients were divided into two groups according to improvement after PPI treatment evaluated by FSSG: rapid responders were patients with ≥50 % improvement according to FSSG, and low responders were those with Results Response rate to PPI therapy was 65.5 % (57/87) in RE and 54.9 % (39/71) in NERD, indicating that the PPI treatment was more effective for RE. In RE, risk factors for PPI resistance indicated by univariate analysis were low stature and high body mass index. Low stature was a risk factor in multivariate analysis. With regard to NERD, univariate analysis indicated that female gender, high stature, low body weight, and low total FSSG score were risk factors for PPI resistance. Low FSSG score was a risk factor in multivariate analysis. Conclusions By the present study, we identified the risk factors for PPI resistance in RE and GERD using FSSG.
    Esophagus 01/2015; DOI:10.1007/s10388-014-0477-x · 0.74 Impact Factor
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    ABSTRACT: Background PillCam patency capsule (PC) is a novel and radiofrequency identification tag-free device that remains intact in the gastrointestinal tract for 30-33 h after ingestion and then disintegrates. The aim of this study was to determine the clinical relevance of PC combined with abdominal ultrasonography as a reliable indicator of functional patency. Patients and methods The study was prospective and PillCam PC was administered to consecutive patients with known or suspected small bowel strictures. PC was verified if it was excreted intact in 33 h after administration. Following excretion failure and radiograph detection in the pelvic cavity, ultrasonography was used to detect the PC in relation to the stricture. Results The participants were 52 patients with known or suspected small bowel strictures (58% women, mean age 51 years, including 32 with or suspected Crohn's disease). Twenty-two patients (42.3%) retrieved PC in the stool within 33 h after ingestion. Radiograph identified the four PCs in the colon and eight were not observed. Ultrasonography precisely judged all 17 PCs retained including six PCs at the proximal side of small bowel stricture in the patients considered ineligible for capsule endoscopy (CE). In all eligible patients, CE passed through the small intestine without incident. Conclusion PillCam PC combined with ultrasonography before CE appears to be a reliable indicator of functional patency to predict and minimize the risk of impaction in suspected or even known cases with small bowel stricture. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
    European Journal of Gastroenterology & Hepatology 12/2014; 26(12):1434-8. DOI:10.1097/MEG.0000000000000225 · 2.15 Impact Factor
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    ABSTRACT: Background Helicobacter pylori infection produces progressive mucosal damage that may eventually result in gastric cancer. We studied the changes that occurred in the presence and severity of atrophic gastritis and the prevalence of H. pylori infection that occurred coincident with improvements in economic and hygienic conditions in Japan since World War II.Materials and Methods The prevalence of H. pylori infection and histologic grades of gastric damage were retrospectively evaluated using gastric biopsy specimens obtained over a 40-year period. Gastric atrophy and intestinal metaplasia were scored using the updated Sydney classification system.ResultsThe prevalence of H. pylori and severity of atrophy were examined in 1381 patients including 289 patients examined in the 1970s (158 men; mean age, 44.9 years), 787 in the 1990s (430 men; 44.2 years), and 305 in the 2010s (163 men; 53.2 years). Overall, the prevalence of H. pylori infection decreased significantly from 74.7% (1970s) to 53% (1990s) and 35.1% (2010s) (p < .01). The prevalence of atrophy in the antrum and corpus was significantly lower in the 2010s (33, 19%, respectively) compared to those evaluated in either the 1970s (98, 82%) (p < .001) or 1990s (80, 67%) (p < .001). The severity of atrophy and intestinal metaplasia also declined remarkably among those with H. pylori infection.Conclusions There has been a progressive and rapid decline in the prevalence of H. pylori infection as well a fall in the rate of progression of gastric atrophy among H. pylori-infected Japanese coincident with the westernization and improvements in economic and hygienic conditions in Japan since World War II.
    Helicobacter 12/2014; DOI:10.1111/hel.12193 · 2.99 Impact Factor
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    ABSTRACT: Serotonin type 3 receptor (5-HT3 R) antagonists are potentially useful therapeutic agents for diarrhea-predominant irritable bowel syndrome (IBS-D). To identify biomarkers predicting effectiveness of the 5-HT3 R antagonist (ramosetron) in IBS-D. Irritable bowel syndrome-D Japanese subjects received 2.5 or 5 μg of ramosetron once daily for 4 weeks. Colonic mucosal S100A and tryptophan hydroxylase (TPH) mRNA expression levels were measured before treatment. Genomic DNA was extracted from blood and polymorphisms of TPH1 and TPH2 were analyzed. Forty-two patients (27 men and 15 women, mean age 42 years) with IBS-D were included for analysis. Improvement of IBS symptoms was seen in 26 (61.9%). Baseline S100A10 (p = 0.02) and TPH1 (p = 0.02) expression were significantly higher in the ramosetron responders than in the non-responders. The frequencies of the TPH1 rs4537731G allele in linkage disequilibrium with the TPH1 rs7130929 T allele (11.5% vs 50%, p = 0.003; OR: 12; 95% CI: 2.1-69) along with TPH1 rs211105 C allele (3.8% vs 43.8%, p = 0.0003; OR: 19; 95% CI: 2.1-181) were significantly lower in the responders than in the non-responders. The mean scores of diarrhea at baseline were significantly higher (5.2 vs 3.7, p = 0.005) in patients with TPH1 rs211105 T/T than those with the G allele. TPH1 gene polymorphisms and S100A10 expression, which correlate with 5-HT signaling were associated with ramosetron effectiveness in IBS-D, and may possibly lead to prospective identification of the resistance to treatment. © 2014 John Wiley & Sons Ltd.
    Neurogastroenterology and Motility 11/2014; 27(1). DOI:10.1111/nmo.12473 · 3.42 Impact Factor
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    ABSTRACT: Background: Dysphagia in elderly patients has a major effect on nutrition and the quality of life (QOL). Although several studies showed that aging itself was associated with changes in esophageal motility, the impact of this on the symptom of dysphagia and quality of life is unknown. The aim of this study was to determine the manometric diagnoses of elderly patients with dysphagia and to see if these differed from those in non-elderly patients. Methods: From September 2007 through March 2014, after excluding patients with organic diseases, 47 consecutive older patients > 65 years reporting dysphagia (men/women, 24/23; mean age 73.0 years) (group A) were compared with those from 42 middle-aged patients with dysphagia (men/women, 18/24; mean age 56.5 years) (group B) and 27 younger patients with dysphagia (men/women, 15/12; mean age 36.1 years) (group C) in regard to symptoms, esophageal motility and health-related QOL (HRQOL). Each patient received ten 5-mL room temperature boluses of saline solution in combined multichannel intraluminal impedance-esophageal manometry examination. They all completed a selfadministered 7-point Likert scale questionnaire about their symptoms and HRQOL based on results of the SF-8. A symptom rated by the patient with a Likert scale score of 4 points or higher was defi ned as a signifi cant symptom. Results: Although all patients had dysphagia as the signifi cant symptom, more elderly patients reported globus sensation and more younger patients reported heartburn as their primary symptom, respectively. Manometricdiagnoses were generally similar among the three groups, although ineffective esophageal motility tended to be diagnosed more in group A compared to group B (Table 1). No signifi cant differences in manometric parameters were detected (Table 2). There were no signifi cant differences in HRQOL among the three groups.
    14th World Congress of International Society for Disease of the Esophagus, Vancouver; 09/2014
  • Gastroenterology 05/2014; 146(5):S-116. DOI:10.1016/S0016-5085(14)60418-2 · 13.93 Impact Factor
  • Gastroenterology 05/2014; 146(5):S-108. DOI:10.1016/S0016-5085(14)60390-5 · 13.93 Impact Factor
  • Gastroenterology 05/2014; 146(5):S-397. DOI:10.1016/S0016-5085(14)61429-3 · 13.93 Impact Factor
  • Gastroenterology 05/2014; 146(5):S-397. DOI:10.1016/S0016-5085(14)61430-X · 13.93 Impact Factor
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    ABSTRACT: Current Japanese gastrointestinal (GI) endoscopic guidelines permit endoscopic biopsy without cessation of antiplatelet agents and warfarin in patients with a therapeutic range of prothrombin time-international normalized ratio (PT-INR) levels, although the evidence levels are low. We evaluated the safety of endoscopic biopsy in patients currently taking antithrombotics. Consecutive patients receiving antithrombotics who underwent GI endoscopy from August 2012 to August 2013 were enrolled. Adverse events and endoscopic hemostasis after biopsy were evaluated. PT-INR level was measured in patients taking warfarin the day before endoscopy. Among 7939 patients undergoing endoscopy, 1034 patients (13.0%, 706 men and 328 women, average age 72.8 years) were receiving antithrombotics. Antithrombotics included aspirin (44.8%), warfarin (34.7%), thienopyridine (16.1%), cilostazol (10.3%), dabigatran (4.8%) etc. PT-INR levels in patients taking warfarin were >3.0 in 13 patients (4.3%), between 2.5 and 3.0 in 18 patients (6.0%), <2.5 in 269 patients (89.7%). Two hundred and six patients received endoscopic biopsy while taking aspirin (51.2%), warfarin (22.8%), and thienopyridine (13.6%). Endoscopic hemostasis was required in three patients after endoscopic biopsy (spraying thrombin in two patients, spraying thrombin and clipping in one patient). There were no major complications. The incidence of endoscopic hemostasis after biopsy in patients without antithrombotic cessation was not significantly different than in the controls not taking antithrombotics (1.5% vs 0.98%, P = 0.51). Endoscopic biopsy did not increase the bleeding risk despite not stopping antithrombotics prior to biopsy even among patients taking warfarin whose PT-INR was within the therapeutic range.
    Digestive Endoscopy 04/2014; 27(1). DOI:10.1111/den.12303 · 1.99 Impact Factor
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    ABSTRACT: Abstract Objective. Fecal hemoglobin-haptoglobin (Hb-Hpt) complex testing is theoretically superior to immunochemical fecal occult blood test detecting human hemoglobin (Hb), as Hb-Hpt is more stable compared to Hb during passage through the gastrointestinal (GI) tract. The aim was to examine the role of fecal Hb-Hpt complex testing in predicting small bowel lesions detected by video capsule endoscopy (VCE). Materials and methods. Stools from patients undergoing small bowel VCE for obscure GI bleeding (OGIB) without ongoing overt bleeding were included. Two stool specimens were obtained on different days just before VCE to measure Hb-Hpt complex by ELISA and Hb by latex agglutination turbidimetric immunoassay. Results. Seventy-six patients (39 men and 37 women, average age 66 years) with suspected small bowel lesions entered. Median Hb-Hpt complex and Hb levels were significantly higher (p < 0.001) in those with small bowel lesions compared to those without. Using the suitable cutoff points (Hb >10 ng/ml and Hb-Hpt complex >5 ng/ml), the sensitivity and specificity of the Hb-Hpt complex test to predict small bowel lesions were 71.4% and 73.3%, and those of the Hb test were 61.2% and 89.3%. Small bowel lesions were found in 58.3% with only Hb-Hpt complex positive results (15.8% of total subjects) compared to 83.3% when both were positive (55.3% of total). Conclusions. Measuring fecal Hb-Hpt complex in addition to Hb may be useful to predict the presence of small bowel lesions in patients with OGIB.
    Scandinavian Journal of Gastroenterology 03/2014; 49(5). DOI:10.3109/00365521.2014.891260 · 2.33 Impact Factor
  • Noriaki Manabe, Ken Haruma
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    ABSTRACT: Purpose To determine the usefulness of contrast-enhanced ultrasonography with the contrast agent Sonazoid™ for the detection of bowel ischemia. Methods From March 2007 to February 2009, 65 patients (35 men and 30 women, mean age 70.4 ± 16.1 years) were enrolled. Fifty-three patients complained of acute abdominal pain with small bowel dilatation (n = 40) or reduced bowel peristalsis (n = 13). Twelve patients were clinically suspected of having bowel ischemia. After Sonazoid™ injection, bowel segments were scanned using harmonic imaging, and the signal intensities were classified as normal or diminished. The definitive diagnosis was confirmed by surgery in 30 patients, autopsy in 6, endoscopy in 3, angiography in 1, and clinical follow-up in 25. Results All 50 patients with normal signal intensities were confirmed not to have bowel ischemia. In the 15 patients with diminished signal intensities, 14 patients were confirmed to have bowel ischemia, resulting in an overall sensitivity of 100% [95% confidence interval (CI) 80.7–100%], a specificity of 98% [95% CI 89.5–99.9%], a positive predictive value of 93% (95% CI 68.1–99.8%), and a negative predictive value of 100% (95% CI 94.1–100%). Conclusion Contrast-enhanced ultrasonography with Sonazoid™ is a highly sensitive and specific method for the diagnosis of bowel ischemia.
    Choonpa Igaku 01/2014; 39(3). DOI:10.3179/jjmu.JJMU.K.7
  • Ken Haruma, Hiroaki Kusunoki, Noriaki Manabe
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    ABSTRACT: We report a case of diffuse esophageal spasm (DES) successfully treated by esophageal long myotomy and Dor’s fundoplication. The patient was a 52-year-old man with a history of hepatitis C and severe chronic heart failure due to hypertensive cardiomyopathy. He had also undergone hemodialysis for chronic renal failure for 10 years. He had complained of dysphagia for 10 years. Diffuse esophageal spasm was diagnosed by fluoroscopy and esophageal manometry. We performed esophageal long myotomy through the opened hiatus and Dor’s fundoplication. The upper extent of the myotomy was confirmed by intraoperative endoscopic ultrasonography used to detect muscle thickening and low compliance of the esophageal wall. The procedure and postoperative recovery were uneventful, and the patient’s symptoms were relieved. This approach appears to be a potentially useful means of treating severe symptoms of DES resistant to conservative therapy, with ultrasound endoscopy being a helpful means of confirming the extent of esophageal myotomy.
    Esophagus 12/2013; 10(4). DOI:10.1007/s10388-013-0398-0 · 0.74 Impact Factor
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    ABSTRACT: Abnormal proximal gastric relaxation is one of the causes of functional dyspepsia. The purpose of this study is to use a barostat in conscious dogs to determine the effects of rikkunshito, which is considered to have beneficial effects on functional dyspepsia, on the proximal stomach. Eight beagles were used. A gastrocutaneous fistula and force transducers were surgically implanted in the middle corpus and gastric antrum and duodenum, respectively. After a recovery period, a plastic bag was inserted through the gastrocutaneous fistula and the proximal stomach was distended using a barostat. First, four dogs were used to investigate the pressure-volume relation in the fasted and postprandial phases. Second, the stomachs of four different dogs were continuously distended at minimal distending pressure +2mmHg, and 5min later were infused with warmed liquid rikkunshito (2g/20mL) or water through the gastrocutaneous fistula. Finally, changes in the proximal gastric volume and gastrointestinal motility were observed. The proximal stomach was significantly more pliable in the postprandial phase than in the fasted phase. The proximal gastric volume increased immediately after liquid infusion under constant pressure in both phases and duodenal motility was accelerated. The effect of rikkunshito was significantly greater and lasted longer than that of water. No significant difference between the effects during the fasted or postprandial phase and no change in the gastric antrum motility were observed when rikkunshito was infused. These results indicate that rikkunshito accelerates duodenal motility and relaxes the proximal stomach.
    Autonomic neuroscience: basic & clinical 07/2013; DOI:10.1016/j.autneu.2013.06.003 · 1.37 Impact Factor
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    ABSTRACT: BACKGROUND: Both ulcerative colitis (UC) and diarrhea-predominant irritable bowel syndrome (IBS-D) are associated with alterations in enteric serotonin (5-HT) signaling. AIMS: The purpose of this study was to compare the rectal and sigmoid colonic mucosal expression of S100A proteins and functional polymorphisms of the 5-HT transporter (5HTT) and interleukin-10 genes in patients with IBS-D or UC with healthy controls. METHODS: mRNA expression of S100 proteins was measured in sigmoid and rectal biopsies and in rectal epithelium isolated by laser-captured microdissection. Leucocyte DNA was analyzed by PCR-based reaction fragment length polymorphisms and direct sequencing. Clinical symptoms were assessed by the self-rating depression scale and by the gastrointestinal symptom rating scale. RESULTS: Fifty patients with IBS-D, 56 with UC and 50 healthy controls were studied. Colonic mucosal expression of S100A8 and S100A9 in UC was significantly higher than in IBS or controls and correlated with the UC disease activity index (r = 0.65, p < 0.001). S100A10 expression in the rectal epithelium of the IBS patients was significantly higher (0.643 vs. 0.402, p = 0.01) than in controls and correlated with the SDS scores (r = 0.41, p = 0.002). The frequency of IL10-819 CC genotype was significantly higher in IBS-D (10.7 vs. 0 %, p = 0.047) and UC (16 vs. 0 %, p = 0.007) than that in controls. CONCLUSION: Overexpression of S100A10 in the rectum may play a role in IBS as it is involved in modulating 5-HT1B receptors. The IL10-819 CC is a candidate genotype for both IBS and UC in Japanese.
    Digestive Diseases and Sciences 04/2013; 58(8). DOI:10.1007/s10620-013-2677-y · 2.55 Impact Factor
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    ABSTRACT: OBJECTIVES:Chronic intestinal pseudo-obstruction (CIPO) is a rare, serious motility disorder, with life-threatening complications over time. However, lack of an established, non-invasive diagnostic method has caused delays in the diagnosis of this intractable disease. Cine-magnetic resonance imaging (MRI) is an emerging technique, with a potential to evaluate the motility of the entire bowel. We compared small bowel motility in healthy volunteers, patients with irritable bowel syndrome (IBS), and those with CIPO, using cine-MRI, and evaluated the usefulness of cine-MRI as a novel diagnostic method for CIPO.METHODS:Twelve healthy volunteers, IBS patients, and CIPO patients prospectively underwent cine-MRI at 1.5 T. Luminal diameter, contraction ratio, and contraction cycle were measured and compared between the groups.RESULTS:Cine-MRI provided sufficient dynamic images to assess the motility of the entire small bowel. Luminal diameter (mean±s.d.) in CIPO patients was significantly higher than that in healthy volunteers and IBS patients (43.4±14.1, 11.1±1.5, and 10.9±1.9 mm, respectively), and contraction ratio was significantly lower in CIPO patients than that in healthy volunteers and IBS patients (17.1±11.0%, 73.0±9.3%, and 74.6±9.4%, respectively). No significant differences were observed in the contraction cycle.CONCLUSIONS:This study is the first to assess the clinical utility of cine-MRI in CIPO patients. Cine-MRI clearly detected contractility impairments in CIPO patients. Cine-MRI is noninvasive, radiation-free, and can directly evaluate the entire small bowel peristalsis, and can detect the affected loops at a glance; therefore, it might be extremely useful for the diagnosis and follow-up of CIPO patients in clinical practice.Am J Gastroenterol advance online publication, 19 March 2013; doi:10.1038/ajg.2013.57.
    The American Journal of Gastroenterology 03/2013; 108(7). DOI:10.1038/ajg.2013.57 · 9.21 Impact Factor
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    ABSTRACT: A 64-year-old man underwent distal gastrectomy for gastric cancer. His postoperative recovery was uneventful until he suddenly started complaining of difficulty swallowing. Fluoroscopy revealed narrowing of the abdominal esophagus into a spindle-like shape. Endoscopic esophageal balloon dilatation was performed with no improvement in his condition. We concluded that the patient could not eat because of mechanical stenosis of the gastroesophageal junction. Reoperation was performed via laparotomy. The abdominal esophagus and gastroesophageal junction were found to have become stiff with adhesions, probably as a result of surgical scarring. We incised the esophageal muscle layer and dissected adhesions around the abdominal esophagus to relieve esophageal stenosis. After reoperation, the patient was able to eat. We recommend that in cases of sudden onset dysphagia after distal gastrectomy, the possibility of secondary achalasia because of scar tissue formation should be considered.
    Esophagus 02/2013; 10(2). DOI:10.1007/s10388-012-0357-1 · 0.74 Impact Factor

Publication Stats

909 Citations
869.42 Total Impact Points


  • 2004–2014
    • Kawasaki Medical University
      • • Department of Laboratory Medicine
      • • Department of Endoscopy and Ultrasound
      • • Department of General Internal Medicine 2
      Kurasiki, Okayama, Japan
  • 2010–2011
    • Kawasaki Saiwai Hospital
      Kawasaki, Fukuoka, Japan
    • Mayo Clinic - Rochester
      Рочестер, Minnesota, United States
  • 2009
    • Numazu City Hospital
      Sizuoka, Shizuoka, Japan
  • 2001–2007
    • Hiroshima University
      • Health Service Center
      Hirosima, Hiroshima, Japan