Takeshi Azuma

Kobe University, Kōbe, Hyōgo, Japan

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Publications (406)2181.11 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: A 66-year-old woman presented to us with malaise, anorexia and rectal mucous discharge, and her laboratory data showed severe hyponatremia, hypokalemia, hypochloremia and renal failure. Computed tomography revealed massive occupation of the rectum by a large tumor. Colonoscopy revealed a mucus-rich villous tumor in the rectum. As there were no other factors that could cause an electrolyte disorder, she was diagnosed with McKittrick-Wheelock syndrome (MWS). The current standard treatment for MWS is partial surgical colectomy. However, surgeries are invasive and postoperative complications sometimes become an issue. After confirming no signs of submucosal invasion of the tumor by magnifying chromoendoscopic examination, endoscopic submucosal dissection (ESD) was indicated. The tumor was completely removed en bloc without adverse events. The histology showed a mucosal adenocarcinoma containing a villous component, 24.5 x 17.0 cm in size. This removal dramatically improved the patient's symptoms and the electrolyte abnormalities without medication. Although several sessions of endoscopic balloon dilation were required to treat postoperative stricture, she has been symptom-free and had no recurrence for 4 years after treatment. We experienced a case of MWS treated by ESD instead of surgery. ESD should be feasible and beneficial for the treatment of MWS.
    Clinical Journal of Gastroenterology 08/2015; DOI:10.1007/s12328-015-0597-4
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    ABSTRACT: The neuropsychiatric test (NP test) is a clinically available modality to confirm minimal hepatic encephalopathy (MHE), but it takes at least 30 minutes for outpatients to complete. An easier primary screening tool of the NP test would be helpful to predict MHE in routine testing on the public METHODS: We performed a prospective cohort study on 59 cirrhotic outpatients at Kobe University Hospital. Laboratory measurements, the NP test, and the chronic liver disease questionnaire (CLDQ) were performed. As an indicator of MHE, cases with and without two abnormal subsets or more in the NP test were compared, and the independent risk factors were statistically examined. Predictive scoring systems of the risk of MHE were established using multivariate logistic regression. CLDQ worry (WO) was the best predictive factor of MHE diagnosed by the NP test (p = 0.006). The predictive model using CLDQ WO discriminated well between patients with and without MHE (AUC: 0.714; 95% CI: 0.582 to 0.824). The predictive scores of MHE enable the patient-specific probability to be easily looked up. CLDQ WO was shown to be an independent factor associated with the NP test to diagnose MHE in cirrhotic patients. The easy predictive scoring system of the risk of MHE using CLDQ WO could become a primary screening tool before performing the NP test in a social setting. This article is protected by copyright. All rights reserved.
    Hepatology Research 07/2015; DOI:10.1111/hepr.12442 · 2.74 Impact Factor
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    ABSTRACT: A variety of treatment modalities including L-carnitine have been tried for cirrhotic patients with minimal hepatic encephalopathy (MHE), which improved MHE for some patients, but were not effective for the other patients. We aimed to identify pre-therapeutic independent factors to predict the amelioration of MHE after L-carnitine treatment. We performed a prospective cohort study on a total of 64 consecutive outpatients of cirrhotic patients who underwent blood biochemical examinations and neuropsychiatric (NP) test at Kobe University Hospital. MHE patients diagnosed by the NP test were orally administered L-carnitine for 3 months. The patients with and without MHE amelioration were compared, and the independent factors were statistically examined. Predictive scoring systems of the amelioration of MHE were established using multivariate logistic regression. The amelioration of MHE was found in 45.8% of MHE patients. Serum taurine before the treatment was the best predictive factor of the amelioration of MHE (p = 0.046). The predictive model using serum taurine discriminated well between patients with and without the amelioration of MHE (AUC: 0.748; 95% CI: 0.531 to 0.901). The predictive scores of the amelioration of MHE enable the patient-specific probability to be easily looked up. Serum taurine before L-carnitine treatment was shown to be an independent factor associated with the amelioration of MHE 3 months after the treatment. The easy pre-therapeutic prediction of MHE amelioration after L-carnitine treatment would help in improving awareness of the selection of MHE patients with good response to L-carnitine, thus being beneficial from a financial perspective. This article is protected by copyright. All rights reserved.
    Hepatology Research 07/2015; DOI:10.1111/hepr.12565 · 2.74 Impact Factor
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    ABSTRACT: Background and study aims: Improvements in the endoscopic submucosal dissection (ESD) technique have made circumferential ESD in the rectum possible. However, little is known about the clinical course after extensive ESD in the rectum. The aim of this study was to determine the stricture risk in the rectum after total or subtotal circumferential ESD. Patients and methods: A total of 69 patients with 69 rectal tumors that required ≥ 75 % circumferential resection were identified at Kobe University Hospital and an affiliated hospital between April 2005 and May 2014. Among the patients, 61 were available for evaluation of stricture development, either by follow-up colonoscopy or by surgical specimens. The rate and possible risk factors of post-ESD strictures were investigated. Results: Post-ESD rectal strictures developed in 12 patients (19.7 %). Patients who underwent total circumferential ESD developed a stricture (5/7, 71.4 %) more frequently than those with subtotal (≥ 90 %) ESD (7/16, 43.8 %). Patients undergoing an ESD procedure that involved < 90 % of the circumference did not develop strictures. The strictures were membranous or < 10 mm long in all cases. Of the patients with stricture, 11 received endoscopic balloon dilation and one received bougie with short-caliber-tip transparent hood; all strictures improved following dilation therapy. Statistical analysis revealed that ≥ 90 % circumferential resection was an independent risk factor for stricture, whereas morphology and size were not. Conclusions: Patients who underwent total or subtotal circumferential ESD of a rectal tumor had a high risk of stricture formation. Dilation helped to alleviate the stenosis.Study registered at University Hospital Medical Information Network (UMIN 000016559). © Georg Thieme Verlag KG Stuttgart · New York.
    Endoscopy 07/2015; DOI:10.1055/s-0034-1392514 · 5.05 Impact Factor
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    ABSTRACT: Quasispecies of hepatitis B virus (HBV) with variations in the major hydrophilic region (MHR) of the HBV surface antigen (HBsAg) can evolve during infection, allowing HBV to evade neutralizing antibodies. These escape variants may contribute to chronic infections. In this study, looked for the MHR variants in HBV quasispecies using ultra-deep sequencing and evaluated the relationship between these variants and clinical manifestations. We enrolled 30 Indonesian patients with hepatitis B infection (11 with chronic hepatitis and 19 with advanced liver disease). The most common sub-genotypes/subtypes of HBV were B3/adw (97%). The HBsAg titre was lower in patients with advanced liver disease than in those with chronic hepatitis. The MHR variants were grouped based on the percentage of the viral population affected: major, ≥ 20% of the total population; intermediate, 5%-20%; and minor, 1%-5%. The rate of MHR variation which present in the major and intermediate viral population were significantly greater in patients with advanced liver disease than in chronic patients. The most frequent MHR variants related to immune evasion in the major and intermediate populations were P120Q/T, T123A, P127T, Q129H/R, M133L/T, and G145R. The major population of MHR variants causing impaired of HBsAg secretion (e.g., G119R, Q129R, T140I, and G145R) was only detected in advanced liver disease patients. This is the first study to use ultra-deep sequencing for detecting MHR variants of HBV in Indonesian patients. We found that a greater number of MHR variation was related to disease severity and a reduced likelihood of HBsAg titre.
    Journal of clinical microbiology 07/2015; 53(10). DOI:10.1128/JCM.00602-15 · 3.99 Impact Factor
  • Journal of Gastroenterology 06/2015; 50(7). DOI:10.1007/s00535-015-1074-z · 4.52 Impact Factor
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    ABSTRACT: Our understanding of the mechanism of cancer dormancy is emerging, but the underlying mechanisms are not fully understood. Here we analyzed mouse xenograft tumors derived from human breast cancer tissue and the human breast cancer cell line MDA-MB-231 to identify the molecules associated with cancer dormancy. In immunohistological examination using the proliferation marker Ki-67, the tumors included both proliferating and dormant cancer cells, but the number of dormant cells was remarkably increased when they metastasized to the lung. In the gene expression analysis of the orthotopic cancer cells by a single-cell multiplex real-time quantitative reverse transcription PCR followed by flow cytometric analysis, restrained cellular proliferation was associated with downregulation of the chemokine receptor CXCR4. In the immunohistological and flow cytometric analyses, the expression level of CXCR4 in the metastasized cancer cells was decreased compared with that in the cancer cells in orthotopic tumors, although the expression level of the CXCR4 ligand CXCL12 was not reduced in the lung. In addition, the proliferation of the metastasized cancer cells was further decreased by the CXCR4 antagonist administration. In the ex vivo culture of the metastasized cancer cells, the expression level of CXCR4 was increased, and in the xenotransplantation of ex vivo cultured cancer cells, the expression level of CXCR4 was again decreased in the metastasized cancer cells in the lung. These findings indicate that CXCR4 is downregulated in metastasized breast cancer cells and implicated in their dormancy.
    PLoS ONE 06/2015; 10(6):e0130032. DOI:10.1371/journal.pone.0130032 · 3.23 Impact Factor
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    ABSTRACT: During colorectal endoscopic submucosal dissection (ESD), the feature of a muscle layer being pulled toward a neoplastic tumor is sometimes detected. We call this feature the muscle-retracting sign (MR sign). The aim of this study was to evaluate whether the MR sign is associated with particular types of neoplastic lesions and whether it has any clinical significance for ESD sessions. A total of 329 patients underwent ESD for 357 colorectal neoplasms. The frequency of positivity for the MR sign was evaluated in different morphologic and histopathologic types of neoplasm. The success rate of complete resection and the incidence of complications were also evaluated according to whether lesions were positive or negative for the MR sign. The rates of positivity for the MR sign in the various lesion types were as follows: laterally spreading tumor - granular nodular mixed type (LST-G-M), 9.6 %; laterally spreading tumor - granular homogeneous type (LST-G-H) and laterally spreading tumor - nongranular type (LST-NG), 0 %; sessile type, 41.2 %. The resection rate was 100 % (329 /329) in lesions negative for the MR sign; however, it was 64.3 % (18 /28) in lesions positive for the MR sign, which was significantly lower (P < 0.001). The MR sign was present only in some protruding lesions, and more importantly, it was associated with a high risk of incomplete tumor removal by ESD. Our data indicate that lesions positive for the MR sign lesions should be dissected with great caution; alternatively, based on the features of the individual case, a switch to surgery should be considered for the benefit of the patient.
    05/2015; 3(3). DOI:10.1055/s-0034-1391665
  • Gastrointestinal Endoscopy 05/2015; 81(5):AB277. DOI:10.1016/j.gie.2015.03.1389 · 5.37 Impact Factor
  • Yoshinori Morita · Tetsuya Yoshizaki · Takeshi Azuma
    Gastrointestinal Endoscopy 05/2015; 81(5):AB451. DOI:10.1016/j.gie.2015.03.851 · 5.37 Impact Factor
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    ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) is histologically characterized by the aberrant accumulation of lipid droplets in the liver, which is positively correlated with insulin resistance. Within the spectrum of this disease, patients can develop hepatitis and cirrhosis; i.e., non-alcoholic steatohepatitis (NASH). The mechanisms responsible for the progression of NAFLD are not fully understood. Triacylglycerol (TAG), which is mainly found in lipid droplets, is currently considered to act as a buffer against the accumulation of non-TAG toxic lipid species. In line with this, recent studies have revealed that insulin resistance is driven by the accumulation of phosphatidic acid and diacylglycerol in hepatocytes and that cholesterol-overloaded stellate cells are associated with fibrosis in the liver. Therefore, it is important to identify the toxic lipid species that contribute to NAFLD progression in order to clarify the pathogenesis of NASH and find novel targets for its treatment. In this review, we divided lipids into five classes; i.e., into fatty acyls, glycerophospholipids, glycerolipids, sphingolipids, and sterol lipids, and described their molecular structures, distributions, and metabolism under physiological conditions, as well as the contributions they make to the progression of NAFLD.
    Current drug targets 04/2015; · 3.02 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-137. DOI:10.1016/S0016-5085(15)30471-6 · 16.72 Impact Factor
  • Yoshihiko Yano · Takeshi Azuma · Yoshitake Hayashi
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    ABSTRACT: Hepatitis B virus (HBV) infection is major global issue, because chronic HBV infection is strongly associated with liver cancer. HBV spread worldwide with various mutations and variations. This variability, called quasispecies, is derived from no proof-reading capacity of viral reverse transcriptase. So far, thousands of studies reported that the variety of genome is closely related to the geographic distribution and clinical characteristics. Recent technological advances including capillary sequencer and next generation sequencer have made in easier to analyze mutations. The variety of HBV genome is related to not only antigenicity of HBs-antigen but also resistance to antiviral therapies. Understanding of these variations is important for the development of diagnostic tools and the appropriate therapy for chronic hepatitis B. In this review, recent publications in relation to HBV mutations and variations are updated and summarized.
    World Journal of Hepatology 03/2015; 7(3):583-92. DOI:10.4254/wjh.v7.i3.583
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    ABSTRACT: Endoscopic submucosal dissection (ESD) is now widely accepted as a strategy to treat superficial esophageal neoplasms. The rate of adverse events, such as perforation, has been decreasing with the improvement of devices and techniques. In this paper, we report a case of esophageal cancer that had a diverticulum under cancerous epithelium. The diverticulum was not detected during preoperative examination, and led to perforation during the ESD procedure. Our case shows that, although rare, some diverticula can exist underneath the mucosal surface without obvious depression. If there is any sign of hidden diverticula during ESD, surgeons should proceed with caution or, depending on the case, the procedure should be discontinued to avoid adverse events.
    03/2015; 21(10):3121-6. DOI:10.3748/wjg.v21.i10.3121
  • Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 03/2015; 112(3):444-55. DOI:10.11405/nisshoshi.112.444
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    ABSTRACT: Recently, endoscopic submucosal dissection (ESD) has been applied for superficial colorectal neoplasms and the number of publications about it has been increasing, but little is known about the outcomes of colorectal ESD for the lesions >50 mm. In this study, we evaluated the feasibility and safety of colorectal ESD for the lesions >50 mm compared with the lesions <50 mm. A total of 674 superficial colorectal neoplasms in 629 patients treated by ESD at Kobe University Hospital from July 2008 to July 2013 were included in the analysis. The median operation time (range) in the large lesion group (≥5 cm) was 109 (37 to 596) minutes, and it was 55 (6 to 248) minutes in the small lesion group (<5 cm). Median procedure speed (range) in the large lesion group was 0.28 (0.06 to 0.83) cm/min, and it was 0.19 (0.04 to 0.83) cm/min in the small lesion group. The en bloc resection rate and the curative resection rate in the small lesion group was 98.7% and 96.0%, and those were 95.7% and 91.4% in the large lesion group, respectively. In terms of adverse events, perforation, muscle damage, and postoperative bleeding occurred at similar frequency in both groups. ESD on colorectal lesions >50 mm takes longer operation time; however, it is resected time effectively without increasing the risk of adverse events compared with smaller lesions by ESD.
    Surgical laparoscopy, endoscopy & percutaneous techniques 03/2015; 25(3). DOI:10.1097/SLE.0000000000000135 · 1.14 Impact Factor
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    ABSTRACT: Afferent loop obstruction caused by cancer recurrence after pancreaticoduodenectomy (PD) can be managed by either surgical or nonsurgical treatment. The general condition of patients with recurrent pancreaticobiliary cancer is often not good enough for them to undergo surgery, so less invasive nonsurgical treatment is desirable. We report a case of a 66-year-old male who had undergone PD for pancreatic head adenocarcinoma 10 months previously and who presented at our hospital with fever and jaundice due to afferent loop obstruction caused by pancreatic cancer recurrence. An endoscopic self-expandable metal stent (SEMS) was placed for afferent loop obstruction without any complications. He quickly recovered after SEMS placement. He retained a good quality of life by receiving chemotherapy until his death due to cancer progression. Our case indicates that this method could be an easy, effective, safe, and less invasive treatment, which may confer a better quality of life for patients with afferent loop obstruction due to cancer recurrence after PD.
    Clinical Journal of Gastroenterology 02/2015; 8(2). DOI:10.1007/s12328-015-0556-0
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    ABSTRACT: Finding a noninvasive method to predict liver fibrosis using inexpensive and easy-to-use markers is important. We aimed to clarify whether NX-des-γ-carboxyprothrombin (NX-DCP) could become a new noninvasive model to predict liver fibrosis in hepatitis C virus (HCV) related liver disease. We performed a prospective cohort study on a consecutive group of 101 patients who underwent liver biopsy for HCV-related liver disease at Kobe University Hospital. Laboratory measurements were performed on the same day as the biopsy. Factors associated with significant fibrosis (F3-4) were assessed by multivariate analyses. A comparison of predictive ability between multivariate factors and abovementioned noninvasive models was also performed. Increase in serum NX-DCP was significantly related to increase in fibrosis stage (P = 0.006). Moreover, NX-DCP was a multivariate factor associated with the presence of significant fibrosis F 3-4 (median 21 of F0-2 group vs. median 22 of F3-4 group with P = 0.002). The AUC of NX-DCP showed no significant differences compared with those of the AST-to-platelet ratio index (APRI), modified-APRI, the Göteborg University Cirrhosis Index (GUCI), the Lok index, the Hui score, cirrhosis discriminating score (CDS) and the Pohl score (P > 0.05). NX-DCP correlated positively with fibrosis stage and could discriminate well between HCV-related patients with or without significant fibrosis. Moreover, NX-DCP had a similar predictive ability to the abovementioned models, and thereby could be a new noninvasive prediction tool for fibrosis.
    Hepatitis Monthly 02/2015; 15(2):e22978. DOI:10.5812/hepatmon.22978 · 1.93 Impact Factor
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    ABSTRACT: New strategies for the care of irritable bowel syndrome (IBS) are developing and several novel treatments have been globally produced. New methods of care should be customized geographically because each country has a specific medical system, life style, eating habit, gut microbiota, genes and so on. Several clinical guidelines for IBS have been proposed and the Japanese Society of Gastroenterology (JSGE) subsequently developed evidence-based clinical practice guidelines for IBS. Sixty-two clinical questions (CQs) comprising 1 definition, 6 epidemiology, 6 pathophysiology, 10 diagnosis, 30 treatment, 4 prognosis, and 5 complications were proposed and statements were made to answer to CQs. A diagnosis algorithm and a three-step treatment was provided for patients with chronic abdominal pain or abdominal discomfort and/or abnormal bowel movement. If more than one alarm symptom/sign, risk factor and/or routine examination is positive, colonoscopy is indicated. If all of them, or the subsequent colonoscopy, are/is negative, Rome III or compatible criteria is applied. After IBS diagnosis, step 1 therapy consisting of diet therapy, behavioral modification and gut-targeted pharmacotherapy is indicated for four weeks. Non-responders to step 1 therapy proceed to the second step that includes psychopharmacological agents and simple psychotherapy for four weeks. In the third step, for patients non-responsive to step 2 therapy, a combination of gut-targeted pharmacotherapy, psychopharmacological treatments and/or specific psychotherapy is/are indicated. Clinical guidelines and consensus for IBS treatment in Japan are well suited for Japanese IBS patients; as such, they may provide useful insight for IBS treatment in other countries around the world.
    Journal of Gastroenterology 12/2014; 50(1). DOI:10.1007/s00535-014-1017-0 · 4.52 Impact Factor
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    ABSTRACT: Proton-pump inhibitors are known to be effective in the treatment and prevention of ulcers related to low-dose aspirin (LDA), but few reports address H2 -receptor antagonists (H2RAs) and gastroprotective agents (GPs). This study was intended to compare the therapeutic effects of an H2RA and a GP against gastroduodenal mucosal injuries in patients taking LDA. The subjects consisted of patients requiring continuous LDA treatment, in whom no peptic ulcer was found on endoscopy at enrollment. The patients were randomized to either famotidine 20 mg/day (group F) or teprenone 150 mg/day (group T). The study medication was administered for 12 weeks. The patients underwent endoscopy after administration of the study medication in order to obtain a Lanza score. A total of 66 patients (38 in group F, 28 in group T) were included in the efficacy analysis population. The Lanza score changed as follows: in group F, it improved significantly, from 0.89 ± 1.03 (mean ± standard deviation) before medication to 0.39 ± 0.75 after medication (P = 0.006); in group T, no significant difference was observed: 0.75 ± 0.93 before medication and 0.68 ± 0.82 after medication. Famotidine is better than teprenone in terms of reducing the number of the erosions under use of LDA. © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.
    Journal of Gastroenterology and Hepatology 12/2014; 29 Suppl S4(S4):11-15. DOI:10.1111/jgh.12768 · 3.50 Impact Factor

Publication Stats

8k Citations
2,181.11 Total Impact Points


  • 2006–2015
    • Kobe University
      • • Division of Gastroenterology
      • • Department of Internal Medicine
      • • Graduate School of Medicine
      Kōbe, Hyōgo, Japan
  • 2010
    • Kobe Gakuin University
      Kōbe, Hyōgo, Japan
  • 2008
    • Tohoku University
      • Institute of Development, Aging and Cancer
      Sendai, Kagoshima, Japan
  • 2001–2008
    • University of Fukui
      Hukui, Fukui, Japan
    • Shiga University of Medical Science
      Ōtu, Shiga Prefecture, Japan
  • 1984–2008
    • Kyoto Prefectural University of Medicine
      • Division of Preventive Medicine
      Kioto, Kyōto, Japan
  • 1998–2007
    • Fukui University
      Hukui, Fukui, Japan
    • Okinawa Chubu Hospital
      Okinawa, Okinawa, Japan
    • University Hospitals Of Leicester NHS Trust
      Leiscester, England, United Kingdom
  • 2004
    • Fukui General Hospital
      Hukui, Fukui, Japan
  • 2002
    • Hokkaido University
      • Graduate School of Science
      Sapporo, Hokkaidō, Japan
    • Tokyo Medical University
      Edo, Tokyo, Japan
  • 2000
    • Fukui Prefectural University
      Hukui, Fukui, Japan
  • 1988–1995
    • Wayne State University
      • School of Medicine
      Detroit, Michigan, United States
  • 1992–1993
    • Kyoto Prefectural University
      Kioto, Kyōto, Japan
    • University of Texas Southwestern Medical Center
      • Department of Pediatrics
      Dallas, TX, United States