Mitsuro Chiba

Akita University Hospital, Akita, Akita, Japan

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Publications (40)120.45 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Current chronic diseases are a reflection of the Westernized diet that features a decreased consumption of indigestible dietary fiber metabolized by gut bacteria to butyrate, which has a critical role in colonic homeostasis. The authors report on initiating a semivegetarian diet (SVD) for patients with inflammatory bowel disease. There was no untoward effect of the SVD. The remission rate with combined infliximab and SVD for patients with newly diagnosed Crohn Disease was 100%. Maintenance of remission on SVD without scheduled maintenance therapy with biologic drugs was 92% at 2 years. The authors recommend a high fiber intake to treat Crohn Disease.
    The Permanente journal 02/2015; 19(1):58-61. DOI:10.7812/TPP/14-124
  • Mitsuro Chiba · Tatsuya Yoshida · Masafumi Komatsu
    Digestive Diseases and Sciences 10/2014; 59(12). DOI:10.1007/s10620-014-3399-5 · 2.61 Impact Factor
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    ABSTRACT: There is limited information in the use of antitumor necrosis factor α, infliximab, in patients on hemodialysis. In Crohn's disease (CD), only 3 cases are reported.A 76-year-old man on hemodialysis for renal failure caused by immunoglobulin A nephropathy developed diarrhea and abdominal pains. A marked edema was observed in the pretibia and ankle. An increase of C-reactive protein (CRP) and erythrocyte sedimentation rate, hypoalbuminemia, hypocholesterolemia, and moderate anemia was found. Ultrasonography and computed tomography (CT) found wall thickness in the left colon. Sigmoidoscopy revealed multiple ulcers in the sigmoid colon and noncaseating epithelioid granuloma was found in the biopsy specimen. Barium enema study exhibited collar button signs and longitudinal ulcers in the left colon.A severe form of CD was diagnosed. Metronidazole seemed to decrease CRP but was ineffective in ameliorating diarrhea. Infliximab rather than steroid hormone was chosen for the treatment. Standard induction therapy with infliximab was initiated. Symptoms rapidly improved then disappeared. CD activity index decreased from 747 to a remission level of 134 after 2 infusions of infliximab. Scheduled maintenance infliximab therapy was administered after the induction therapy. Ultrasonography and CT showed a disappearance of the wall thickness of the colon. Adverse reactions were not observed.Infliximab was effective and safe in a patient with CD on hemodialysis. Our case has added additional literature in accordance with previous reports supporting infliximab as effective and safe in patients on hemodialysis.
    Medicine 07/2014; 93(7):e54. DOI:10.1097/MD.0000000000000054 · 5.72 Impact Factor
  • Mitsuro Chiba · Hideo Ohno · Hajime Ishii · Masafumi Komatsu
    The Permanente journal 01/2014; 18(4):94. DOI:10.7812/TPP/14-117
  • Health 01/2014; 06(10):926-928. DOI:10.4236/health.2014.610116 · 0.51 Impact Factor
  • Kanzo 01/2014; 55(5):267-273. DOI:10.2957/kanzo.55.267
  • Health 01/2014; 06(10):969-974. DOI:10.4236/health.2014.610122 · 0.51 Impact Factor
  • Mitsuro Chiba · Tsuyotoshi Tsuji · Masafumi Komatsu
    Digestive Diseases and Sciences 11/2013; 59(1). DOI:10.1007/s10620-013-2954-9 · 2.61 Impact Factor
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    ABSTRACT: Diffuse gastroduodenitis resembling ulcerative colitis in respect to macro- and microscopic findings occurs in ulcerative colitis, although it is rare. Reports of gastroduodenitis associated with ulcerative colitis treated with infliximab are rare. A 58-year-old man had tarry stool in March 2011. He had a history of ulcerative colitis that was diagnosed in 1984. He underwent subtotal colectomy in 1991. Endoscopy and radiography revealed diffuse friable mucosa throughout the duodenum and an ulcer in the middle of the descending portion, resulting in a narrow portion.In the stomach, numerous small aphthae were observed in the antrum. Biopsy specimens of the duodenum and antrum showed marked inflammatory cell infiltration in both areas and cryptitis in the duodenum. Standard induction therapy of infliximab was started in April. The ulcer in the descending portion became a scar without diffuse mucosal friability in September 2011.
    Digestive Endoscopy 11/2013; 25(6):622-5. DOI:10.1111/j.1443-1661.2012.01398.x · 2.06 Impact Factor
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    Mitsuro Chiba · Toru Abe · Satoko Tsuda · Iwao Ono
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    ABSTRACT: Background In 2009, a trigger role of cytomegalovirus (CMV) was shown in the development of ulcerative colitis (UC) in mice. Fifteen cases of synchronous onset of CMV colitis and UC have been reported in literature. A careful prospective and retrospective survey identified CMV colitis in newly diagnosed UC patients at 4.5% (3/65 cases) and 8.2% (5/61 cases), respectively. This means that a majority of synchronous CMV colitis may be missed in newly diagnosed UC patients in routine practice. Such a case is presented. Case presentation A 50-year-old woman, with a history of right partial mastectomy two years ago, had a persistent high fever for 9 days, after which a thickness of the colonic wall was detected on abdominal ultrasonography. Laboratory data showed inflammation and 2% atypical lymphocytes with the normal number of white blood cells. Although there was no bloody stool, fecal occult blood was over 1000 ng/ml. Colonoscopy showed diffuse inflammation in the entire large bowel and pseudomembranes in the sigmoid colon. The diagnosis was UC with antibiotic-associated pseudomembranous colitis. Metronidazole followed by sulfasalazine resulted in defervescence and improvement in laboratory data of inflammation. It took one month for normalization of fecal occult blood. Endoscopic remission was simultaneously confirmed. Later, it was found that a report of positive CMV antigenaemia (2/150,000) had been missed. Reevaluation of biopsy specimens using a monoclonal antibody against CMV identified positive cells, although inclusion bodies were not found in hematoxylin and eosin sections. Finally, the case was concluded to be synchronous onset of CMV colitis and UC. Conclusion Synchronous CMV colitis is not routinely investigated in newly diagnosed UC patients. Together with a recent observation in animal studies, it is plausible that a subset (a few to several per cent) of UC patients develop synchronous CMV infection. Further studies are needed to elucidate the plausibility.
    BMC Research Notes 02/2013; 6(1):40. DOI:10.1186/1756-0500-6-40
  • Mitsuro Chiba · Hidehiko Tsuda · Takeshi Sugawara · Iwao Ono
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    ABSTRACT: The small bowel is the least common site of involvement in the gastrointestinal tract for cytomegalovirus (CMV) infection. CMV enteritis results in a high rate of emergency surgery for bleeding, perforation, or ileus and a high mortality rate. We report on successful medical treatment for a case of life-threatening severe CMV enteritis. A 71-year-old man, not known to be immunocompromised, suffered diarrhea and periumbilical abdominal pain. Diarrhea persisted and hypoalbuminemia developed, which required total parenteral nutrition. Colonoscopy revealed erosions and redness in the terminal ileum. Esophagogastroduodenoscopy revealed diffuse edema in the duodenum. Enteroclysis showed a narrow and shortened small bowel with an extremely short transit time of the small bowel of <1 min. CMV antigenemia was found on the blood sample. The biopsy specimens from both the duodenum and terminal ileum showed cell infiltration with dominance of eosinophils indicating eosinophilic enteritis. Therefore, ganciclovir 500 mg/day and prednisolone 40 mg/day were started. The diarrhea gradually improved, and a semi-vegetarian diet was started; thereafter, the patient fully recovered. Inclusion bodies were not found in routine hematoxylin–eosin stained sections of the duodenal or ileal specimens. However, a re-evaluation by immunohistochemistry using a monoclonal antibody against CMV revealed positive cells for CMV in both specimens.
    Clinical Journal of Gastroenterology 06/2012; 5(3). DOI:10.1007/s12328-012-0305-6
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    ABSTRACT: Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) of unknown etiology. We aimed to identify the etiological agent of CD using a molecular cloning strategy that was particularly focused on identifying agents causing immune abnormalities and infectious agents. We constructed a cDNA library derived from the inflamed intestinal tissue of a CD patient, and screened 1.5 million clones in this library with the serum from another typical CD patient. The expressed cDNA clones that positively reacted with the serum were then expressed as fusion proteins with glutathione S-transferase, and western blotting was performed using the sera of 22 CD, 13 ulcerative colitis (UC), and 16 non-IBD patients. We identified nine positive clones that did not contain any viral or bacterial genomic DNA. Of these, we selected one clone (clone 50) with which the typical CD patient's serum most strongly reacted. Clone 50 is highly homologous to the antioxidant protein peroxiredoxin 6. In western blotting, the sera of 47.6% CD patients (small intestine type 80%, large and small intestine type 43%, large intestine type 0%) showed strong reactivity to clone 50, none of the UC patients were reactive to clone 50, and 18.8% of non-IBD patients were very weakly reactive to it. We also found that the expression of peroxiredoxin 6 was significantly increased in inflamed intestinal epithelia of CD. The present study first showed that some CD patients have an antibody against peroxiredoxin 6-like protein, which may be involved in the pathogenesis of CD.
    Journal of Gastroenterology and Hepatology 04/2012; 27(8):1388-94. DOI:10.1111/j.1440-1746.2012.07147.x · 3.50 Impact Factor
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    Inflammatory Bowel Diseases 05/2011; 17(8):E82-3. DOI:10.1002/ibd.21745 · 4.46 Impact Factor
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    ABSTRACT: To investigate whether semi-vegetarian diet (SVD) has a preventive effect against relapse of Crohn's disease (CD) in patients who have achieved remission, who are a high-risk group for relapse. A prospective, single center, 2-year clinical trial was conducted. Twenty-two adult CD patients who achieved clinical remission either medically (n = 17) or surgically (n = 5) and consumed an SVD during hospitalization were advised to continue with an SVD and avoid known high-risk foods for inflammatory bowel disease. The primary endpoint was clinical relapse defined as the appearance of active symptoms of CD. Kaplan-Meier survival analysis was used to calculate the cumulative proportion of patients who had a relapse. A 2-year analysis of relapse rates of patients who followed an SVD and those who did not (an omnivorous diet group) was undertaken. SVD was continued by 16 patients (compliance 73%). Remission was maintained in 15 of 16 patients (94%) in the SVD group vs two of six (33%) in the omnivorous group. Remission rate with SVD was 100% at 1 year and 92% at 2 years. SVD showed significant prevention in the time to relapse compared to that in the omnivorous group (P = 0.0003, log rank test). The concentration of C-reactive protein was normal at the final visit in more than half of the patients in remission who were taking an SVD, who maintained remission during the study (9/15; 60%), who terminated follow-up (8/12; 67%), and who completed 2 years follow-up (7/10; 70%). There was no untoward effect of SVD. SVD was highly effective in preventing relapse in CD.
    World Journal of Gastroenterology 05/2010; 16(20):2484-95. · 2.37 Impact Factor
  • Digestive Endoscopy 04/2010; 22(2):160. DOI:10.1111/j.1443-1661.2010.00946.x · 2.06 Impact Factor
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    Mitsuro Chiba
    World Journal of Gastroenterology 01/2010; 16(20):2484. DOI:10.3748/wjg.v16.i20.2484 · 2.37 Impact Factor
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    ABSTRACT: There have only been a few reports on lansoprazole-associated collagenous colitis. Colonic mucosa of collagenous colitis is known to be endoscopically normal. We present a case of collagenous colitis where the mucosa showed diffuse cloudiness mimicking ulcerative colitis. A 70-year-old woman developed watery diarrhea four to nine times a day. She had interstitial pneumonia at 67 and reflux esophagitis at 70 years. Lansoprazole 30 mg/d had been prescribed for reflux esophagitis for nearly 6 mo. Lansoprazole was withdrawn due to its possible side effect of diarrhea. Colonoscopy disclosed diffuse cloudiness of the mucosa which suggested ulcerative colitis. Consequently sulfasalazine 2 g/d was started. The patient's diarrhea dramatically disappeared on the following day. However, biopsy specimens showed subepithelial collagenous thickening and infiltration of inflammatory cells in the lamina propria, confirming the diagnosis of collagenous colitis. One month after sulfasalazine therapy was initiated, colonoscopic and histological abnormalities resolved completely. Five months later the diarrhea recurred. The findings on colonoscopy and histology were the same as before, confirming a diagnosis of collagenous colitis relapse. We found that the patient had begun to take lansoprazole again 3 mo ahead of the recent diarrhea. Withdrawal of lansoprazole promptly resolved the diarrhea. Endoscopic and histological abnormalities were also completely resolved, similar to the first episode. Retrospectively, the date of commencement of sulfasalazine and discontinuation of lansoprazole in the first episode was found to be the same. We conclude that this patient had lansoprazole-associated collagenous colitis.
    World Journal of Gastroenterology 06/2009; 15(17):2166-9. · 2.37 Impact Factor
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    Inflammatory Bowel Diseases 11/2008; 15(8):1121-2. DOI:10.1002/ibd.20769 · 4.46 Impact Factor
  • Journal of Gastroenterology and Hepatology 07/2008; 16(8):951 - 952. DOI:10.1111/j.1440-1746.2001.2379f.x · 3.50 Impact Factor
  • Mitsuro CHIBA · Toshio SUZUKI · Yasuo HORIE · Osamu MASAMUNE
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    ABSTRACT: An unusual form of aphthoid colitis is presented. A 21 -year-old man complained of hematochezia for about 2 years. Examinations revealed crowded polypoid lesions in the lower rectum: the closer to the anus the site was, the bigger the size of the polypoid lesions. Polypoid lesions were also observed in the terminal ileum and on the ileocecal valve. Biopsy specimens revealed that these polypoid lesions were lymph follicles. Lymphoid hyperplasia was observed in the upper rectum and proximal colon but not in the transverse colon. The patient was given a salicylazosulfapyridine suppository followed by a rapid ceasing of hematochezia on the following day and disappearance of most lymph noduli in the rectum by the second week. About two years later hematochezia recurred. The findings of the lower rectum and the response to the suppository were the same as in the first episode. Known diseases associated with aphthoid colitis were ruled out.The present case is unusual in several respects compared to typical apthoid colitis: the clinical course is not acute self-limited but chronic protracted; the lesions are distributed not evenly in the large bowel or its segment(s) but in the lower rectum, in addition, the lesions become more pronounced toward the anus; skipped lymph noduli are observed in the ileocecal valve and the terminal ileum. The other characteristics of this case include a marked response to salicylazosulfapyridine, recurrence, no precedence of flu-like syndromes, no symptoms except for hematochezia, and normal laboratory data.
    Digestive Endoscopy 08/2007; 6(3):258 - 264. DOI:10.1111/j.1443-1661.1994.tb00376.x · 2.06 Impact Factor

Publication Stats

80 Citations
120.45 Total Impact Points


  • 1998–2014
    • Akita University Hospital
      Akita, Akita, Japan
  • 2008–2013
    • Akita General Hospital
      Akita, Akita, Japan
  • 1990
    • Akita University
      • First Department of Internal Medicine
      Akita, Akita-ken, Japan