Publications (26)50.78 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Only few large-scale epidemiological studies have examined the prevalence of Helicobacter pylori (H. pylori) infection in Japan. The aim of the present study was to estimate the prevalence and incidence of H. pylori infection in Japan in terms of gender, age and region. Serum anti-H. pylori antibody testing was included in workers' annual health checks conducted by T-company's health insurance association in 2008. The testing was continued for the next 5 years in 35-year-old subjects. The total number of subjects was 21 144 (18 398 males and 2746 females). Stratified for age, there were 5016 subjects (male : female = 4219:797) in their 30s, 8748 (7770:978) in their 40s, 5589 (4807:782) in their 50s, and 1769 (1584:185) in their 60s. The H. pylori seropositive rate (male : female) was 27.5% (27.5:27.7) overall, 18.0% (18.3:16.1) in subjects in their 30s, 22.9% (22.7:24.7) in those in their 40s, 37.4% (37.2:38.2) in those in their 50s, and 46.1% (45.7:49.2) in those in their 60s. The prevalence of H. pylori seropositivity increased as age increased; however, no significant differences were seen between genders or among regions (χ(2) test). The numbers of 35-year-old subjects from 2008 to 2012 were 1072, 1107, 941, 1065, and 940, respectively. The corresponding H. pylori seropositive rates were 17.4, 17.4, 14.3, 13.3, and 14.0%, respectively. The Japanese H. pylori infection rate had already declined to 27.5% in 2008, with subjects in the 35-70 age range. The prevalence of H. pylori infection is also decreasing gradually from 2008 to 2012. © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.
- [Show abstract] [Hide abstract] ABSTRACT: Helicobacter pylori (H. pylori) infection is a strong risk factor for the development of gastric cancer. In 2013, the Japanese government approved H. pylori eradication therapy in patients with chronic gastritis as well as peptic ulcer. However, the continuing decline in eradication rates for first-line H. pylori eradication therapies is an urgent problem. In this study, we investigated changes in the first-line eradication rate from 2001 to 2010. Eradication rates for 7-day triple therapy [proton pump inhibitor (rabeprazole 20 mg, lansoprazole 60 mg, or omeprazole 40 mg) + amoxicillin 1500 mg + clarithromycin (CAM) 400 or 800 mg, daily] were collated from 14 hospitals in the Tokyo metropolitan area. The urea breath test was used for the evaluation of eradication. The cut-off value was less than 2.5%. The yearly eradication rates (intention to treat/per protocol) were 78.5/79.5% (2001, n = 242), 71.2%/72.9% (2002, n = 208), 67.8%/70.5% (2003, n = 183), 75.6%/84.6% (2004, n = 131), 56.4%/70.5% (2005, n = 114), 70.5%/75.8% (2006, n = 271), 67.4%/82.0% (2007,n = 135), 64.0%/76.3% (2008, n = 261), 60.5%/74.3% (2009, n = 329), and 66.5%/78.8% (2010, n = 370), respectively. Examination of eradication rates according to CAM dosage revealed an eradication rate of 65.6% (383/584) for CAM 400 mg daily, and 68.5% (1124/1642) for CAM 800 mg daily, with no significant difference seen between dosages. In recent years, eradication rates for first-line triple therapy have obviously decreased, but no noticeable decrease has occurred after 2001. © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.
- [Show abstract] [Hide abstract] ABSTRACT: In Japan, the eradication rate of first-line therapy for Helicobacter pylori (H. pylori) with a proton pump inhibitor (PPI), amoxicillin (AMPC) and clarithromycin (CAM) has been decreasing because of a high prevalence of CAM resistance. A possible decrease of the eradication rate for second-line therapy with a PPI, AMPC and metronidazole (MNZ) is of concern. The aim of this study is to assess the trends in second-line eradication therapy for H. pylori in Japan. We accumulated data retrospectively on patients administered second-line eradication therapy for Helicobacter pylori with a PPI, AMPC, and MNZ for 1 week after failure of first-line eradication therapy with a PPI, AMPC and CAM at 15 facilities in the Tokyo metropolitan area in Japan from 2007 to 2011. Trends for second-line eradication rates in modified intention-to-treat (ITT) analyses were investigated. Second-line eradication rates were categorized by three PPIs (rabeprazole (RPZ), lansoprazole (LPZ) or omeprazole (OMZ)) and evaluated. We accumulated data on 1373 patients. The overall second-line eradication rate was 92.4%. Second-line eradication rates in 2007, 2008, 2009, 2010 and 2011 were 97.7, 90.6, 94.5, 91.8 and 91.8%, respectively, with no significant trends revealed. Second-line eradication rates categorized by three PPIs for the entire 5-year period were 91.6, 93.4 and 92.4% (RPZ, LPZ and OPZ, respectively) with no significant differences among the three PPIs. From 2007 to 2011, there were no significant trends in the second-line eradication rates and the rates remained consistently high. From the viewpoint of high prevalence of CAM resistance in Japan, triple therapy with PPI, AMPC and MNZ may be a better strategy for first-line therapy compared to triple therapy with PPI, AMPC and CAM.
- [Show abstract] [Hide abstract] ABSTRACT: Ultrathin transnasal endoscopy, used extensively in Japan, is considered to have inferior image quality and suction performance, and questionable diagnostic performance. So the aim of the present study was to compare the diagnostic performance of white light (WL) examination and non-magnified narrow-band imaging (NBI) examination in screening for esophageal disorders with ultrathin transnasal endoscopy. A prospective case study of 105 consecutive patients screened for upper gastrointestinal disorders at a single clinic in Tokyo Medical University Hospital. All subjects were diagnosed using WL, NBI and Lugol-staining examinations. Areas ≥ 5 mm clearly not a Lugol-staining lesion were defined as esophageal disorders and the rates of detection of the two examination methods (WL vs NBI) were compared. For WL examination, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy (concordance rate) for esophageal disorders were 19.6%, 98.1%, 90.9%, 55.4%, and 59.2%, respectively, versus 60.8% 96.2%, 93.9%, 71.4%, and 78.6% for NBI. A useful level of diagnostic performance for esophageal disorders can be achieved with non-magnified narrow-band NBI ultrathin transnasal endoscopy.
- [Show abstract] [Hide abstract] ABSTRACT: Helicobacter pylori infection rates are reported to be high in people over the age of 40 years, but are decreasing in younger age groups. A negative correlation has been reported between H. pylori infection and reflux esophagitis (RE). The subjects were 418 patients who underwent esophagogastroduodenoscopy and measurement of serum immunoglobulin G H. pylori antibodies examined as part of their routine health checks. Their mean age was 39.2 +/- 8.3 years (range 22-58). We analyzed the RE findings (Los Angeles classification: A, B, C, D). The total H. pylori infection rate was 33.7% (141/418). By age group, infection rates were 15.7% in the 20-29 years group, 28.0% in the 30-39 group, 34.3% in the 40-49 group and 69.1% in the 50-59 group. The proportion of H. pylori-negative subjects with RE was 23.5% (20-29, 22.9%; 30-39, 31.7%; 40-49, 32.4%; 50-59, 41.7%), significantly higher than that (12.1%) in H. pylori-positive subjects (20-29, 0%; 30-39, 16.7%; 40-49, 12.2%; 50-59, 10.5%). The severity of RE increased with advancing age in H. pylori-positive subjects, but not in H. pylori-negative subjects. In this study, higher rates of RE were seen in H. pylori-negative subjects. It may be, however, that the presence of H. pylori infection influences the progression of RE.
- [Show abstract] [Hide abstract] ABSTRACT: Helicobacter pylori (H. pylori) eradication rates using the PPI/AC regimen (proton pump inhibitor + amoxicillin + clarithromycin) are declining. We trialed tailoring eradication regimens according to clarithromycin (CAM) susceptibility. The subjects were 70 H. pylori positive adults. They were randomly allocated to a tailored group and a control group. In the tailored group, subjects with CAM-sensitive strains were given PPI/AC eradication therapy, and those with CAM-resistant strains were given PPI/AM (metronidazole instead of clarithromycin) therapy. The control group were all given PPI/AC therapy. CAM sensitivity was measured by collecting fecal specimens, and extracting the DNA. The 23S rRNA domain, associated with CAM susceptibility in H. pylori, was amplified using a nested polymerase chain reaction (PCR), and DNA sequencing was used to detect point mutations at A2143G and A2144G. Eradication rates were 94.3% in the tailored group and 71.4% in the control group. In particular, the eradication rate was 100% for CAM-resistant strains in the tailored group. In Japan, where CAM-resistant H. pylori strains are expected to continue to increase, tailored eradication therapy according to CAM sensitivity will be of benefit.
- [Show abstract] [Hide abstract] ABSTRACT: We used transnasal ultrathin esophagogastroduodenoscopy (UT-EGD) to simultaneously perform realtime esophageal manometry and observe esophageal peristalsis. The subjects were 22 healthy volunteers and 10 patients with proton-pump inhibitor (PPI) dependent gastroesophageal reflux disease (GERD). We induced the primary peristaltic wave associated with swallowing and observed it endoscopically in the lower esophagus, at the same time measuring the intraesophageal pressure using a manometry catheter. The mean primary peristaltic amplitude associated with swallowing was 65.6+/-47.4 mmHg in the volunteer group, and 28.0+/-25.6 mmHg in the GERD group. Although peristalsis was observed endoscopically in the GERD group, in some cases incomplete peristalsis left a small but definite lumen and in these subjects, the primary peristaltic wave was almost flat. The use of an ultrathin transnasal endoscope makes possible simultaneous manometry and endoscopic observation of the esophagus. This combination should prove useful in the evaluation of esophageal peristaltic function, such as in the diagnosing of GERD.
- [Show abstract] [Hide abstract] ABSTRACT: Decreased bone mineral density is a complication to which we should always pay attention in the treatment of Crohn's disease (CD). However, there is still no clear consensus with regard to evaluation methods and the appropriate observation period for its detection. In the present study, we measured the bone mineral density of 30 CD patients who were treated at the outpatient clinic of our institution and investigated its relationship with various clinical characteristics including sex, age, duration of illness, history of enterectomy, total steroid consumption, body weight, and body mass index (BMI) and with bone metabolism markers. A decreased bone mineral density was detected in 9 patients (30%). The bone mineral density did not correlate with total steroid consumption, but showed a negative correlation with the Crohn's disease activity index (CDAI).When bone metabolism markers were investigated, the bone mineral density showed a negative correlation with Glu-osteocalcin (Glu-OC) and serum type I collagen cross-linked N-telopeptide (NTx) in patients with a low bone mineral density. Based on these results, the decrease of bone mineral density in CD patients was considered to the underlying disease itself. Therefore, control of disease activity is very important in CD patients, and periodic measurement of bone mineral density in combination with bone mineral markers (Glu-OC and serum NTx) may be useful for predicting a decrease of bone mineral density.
- [Show abstract] [Hide abstract] ABSTRACT: Diagnostic methods for Helicobacter pylori (H. pylori) infection can be divided into invasive endoscopic methods and non-invasive methods. A typical and widely used non-invasive method is the 13C urea breath test (UBT). In this study, the possibility of a correlation between pre-treatment UBT values with H. pylori antimicrobial resistance is investigated. The subjects were 119 consecutive patients who attended this hospital for H. pylori testing. Average age was 47.5 +/- 13.2 years, with a male:female ratio of 2.05:1. The diagnosis was gastric ulcer in 43 subjects, duodenal ulcer in 27, gastroduodenal ulcer in 21 and chronic gastritis in 28. Subjects underwent UBT as well as upper gastrointestinal endoscopy (UGITE). The diagnosis of H. pylori infection was examined by the results of culture, histological examination and the rapid urease test (RUT). The mean inhibitory concentration (MIC) was determined for each antimicrobial agent in the bacterial isolates that could be cultured. In this study, the sensitivity and specificity were excellent at 97.0% and 100% with a cut-off point of 3.5 per thousand for UBT respectively. Clarithromycin resistance was more common in the group with high UBT values. No correlation at all was seen between UBT values and metronidazole, sparafloxacin, cefaclor and amoxicillin susceptibility. It is possible that UBT values also tend to be higher in cases of CAM resistance.
- [Show abstract] [Hide abstract] ABSTRACT: In Japan, eradication regimens consisting of a proton pump inhibitor (PPI) + amoxicillin (AMPC) + clarithromycin (CAM) (PPI/AC) for 1 week have been conducted. In the present study, we assessed the eradication rates following treatment with low doses of various PPIs. 135 patients were divided randomly into one of three 7-day regimens: (i) omeprazole (OPZ) 20 mg/day + AMPC 1500 mg/day + CAM 600 mg/day (OAC); (ii) lansoprazole (LPZ) 30 mg + AMPC 1500 mg/day + CAM 600 mg/day (LAC); and (iii) rabeprazole (RPZ) 10mg/day + AMPC 1500 mg/ day + CAM 600 mg/day (RAC). The genetic polymorphism of CYP2C19 was also examined. The eradication rates according to the treatment regimen were as follows: 69.9% (31/45) for OAC, 62.2% (28/45) for LAC, and 71.1% (32/45) for RPZ. No significant differences were found among the regimens. Moreover, eradication rates, according to CYP2C19 phenotype (homozygous extensive metabolizer (EM), heterozygous EM, and poor metabolizer) were: 68.6% (35/51), 77.4% (41/53), and 82.4% (14/17), respectively. In PPI/AC therapy, the eradication rate for each low-dose PPI was 60-70%, which is low. Based on previous reports, it is considered that doses greater than 40 mg/day OPZ, 60 mg/day LPZ, and 20 mg/day RPZ are required.
- [Show abstract] [Hide abstract] ABSTRACT: Transnasal esophagogastroduodenoscopy (EGD) is reported to be more pleasant than conventional transoral EGD. In this study, we compared the hemodynamic effects of transnasal and transoral EGD. The subjects were 120 patients with upper gastrointestinal conditions. Transnasal and transoral EGD were performed on 60 subjects each. Oxygen saturation, heart rate and blood pressure were monitored. Subjects were also asked for their condition with each EGD. VAS scores for discomfort at the insertion, and for trouble breathing and nausea during the procedure, were significantly lower for transnasal than for transoral EGD. A significant increase in the heart rate and significant decrease in oxygen saturation were seen only in the transoral group during EGD. The double product (heart rate x systolic blood pressure) was also significantly increased only in the transoral group. No significant changes were seen in the transnasal EGD. Double product has been reported to correlate with myocardial oxygen consumption. Transnasal EGD is a safe technique, and is not only less stressful to patients, but also has fewer hemodynamic effects than the transoral method.
- [Show abstract] [Hide abstract] ABSTRACT: The pepsinogen (PG) test result is used in Japan for screening for gastric cancer. In this study, we investigated the changes in evaluation of the PG test result following H. pylori eradication. The subjects were 120 consecutive H. pylori-positive patients with upper gastrointestinal symptoms. Subjects underwent endoscopy prior to, and at 2 months after the eradication therapy, at which time blood was taken for determination of changes in PG levels. The overall eradication rate was 79.3% (per protocol). Following eradication therapy, the evaluation of PG test result converted from positive to negative in 80.4% (37/46) of cases of successful eradication, and in 0% (0/6) of cases of eradication failure. These results suggest that the evaluation of PG test result should be used after the definitive confirmation of the success or failure of H. pylori eradication therapy.
- [Show abstract] [Hide abstract] ABSTRACT: Background The only authorized second-line Helicobacter pylori regimen in Japan is proton pump inhibitor + amoxycillin + clarithromycin. However, it has been reported that this second-line regimen is not effective. In this study, we evaluated the efficacy of dual and triple eradication therapies using rabeprazole as second-line H. pylori eradication regimens.AimTo evaluate the efficacy of dual and triple eradication therapies using rabeprazole as second-line H. pylori eradication therapy.Methods Sixty-two H. pylori-positive patients with first-line eradication failure were randomly assigned to two groups. The RAM group was administered rabeprazole 20 mg + amoxycillin 1500 mg + metronidazole 500 mg daily for 1 week. The RA group was administered rabeprazole 40 mg + amoxycillin 2000 mg daily for 2 weeks. Eradication of H. pylori infection was determined by 13C-urea breath testing at 8 weeks after completion of treatment. Prior to treatment, amoxycillin, clarithromycin and metronidazole susceptibility, and CYP2C19 phenotype status were determined.ResultsEradication rates for the RAM and RA groups were 97% and 74%, respectively. Eradication rates were not influenced by CYP2C19 phenotype in either group. Eradication rates for clarithromycin-resistant patients were 100% in the RAM group and 77% in the RA group.Conclusions One week with RAM therapy and 2 weeks with RA therapy were effective as second-line eradication therapy for H. pylori infection; moreover, RAM was more effective than RA therapy.
- [Show abstract] [Hide abstract] ABSTRACT: Background Levels of pepsinogen have been reported to correlate with the degree of gastric atrophy in Helicobacter pylori-infected gastric mucosa.AimTo investigate the relationship between PG levels and histological atrophy before and after H. pylori eradication.Methods Eradication therapy was conducted on 180 H. pylori-positive patients with upper gastrointestinal conditions. Endoscopy was performed prior to and at 2, 12 and 24 months after successful eradication therapy. Histological findings were scored using the updated Sydney System in the antrum and the corpus of the stomach. Pepsinogen was measured.ResultsPepsinogen I levels dropped significantly at 2 months after the eradication. By 12 months and 24 months post-eradication they had risen again. Histological improvement was seen in atrophy at all sites at 24 months after the eradication. A significant correlation between atrophy and pepsinogen I was seen from prior to eradication. The correlation coefficient was greater at 2 months post-eradication, decreased again at 12 months and was no longer significant at 24 months.Conclusions Our results suggest that pepsinogen levels correlate with the degree of gastric mucosal atrophy prior to and soon after successful eradication therapy, but that the degree of correlation subsequently declines over time.
- [Show abstract] [Hide abstract] ABSTRACT: Helicobacter pylori (H. pylori) eradication therapy for peptic ulcers is performed at many facilities in Japan. The eradication regimens are consisted of the 7-day triple therapy using lansoprazole (LPZ) or omeprazole (OPZ) + amoxicillin (AMPC) + clarithromycin (CAM). In theses regimens, 2 types of antibacterial drug are included, the method of taking medicine has been problematic. In this study, we evaluated the usefulness of a packaged tablets and capsules that contain eradication drugs. (Product name: Lansap). Subjects and methods: The study was performed in 100 H. pylori positive patients with upper gastrointestinal disease. The regimen of the eradicating drugs was administration for 7 days of LPZ 60 mg + AMPC 1,500 mg + CAM 800 mg. The patients were randomly divided into two groups. One group was prescribed a package sets of tablets /capsules (package group) for taking the regimen, second group were prescribed the tablets /capsules from separate sets (conventional group) for taking the drugs. Eradication was evaluated by C-13 urea breath test 6-8 weeks after completion of the treatment. A questionnaire survey was also performed immediately after completion of the treatment regarding to forgetting to take the medicine, mistaking the dosage (quantity) of medicine, the total dose of medicine, and understanding of adverse effects of drugs. Results: The eradication rate (ITT) was 68.0% in the package group and 72.0% in the conventional group, showing no significant difference. Three and 7 patients forgot to take some drugs in the package and conventional groups, respectively, showing no significant difference. None and 2 patients mistook the dosage of medicine respectively. 29 and 26 patients felt that the total dose too much, respectively. As for understanding of adverse effects of drug, 24 and 25 patients understood them respectively. Conclusion: In H. pylori eradication therapy, package sets of eradication medicine are useful for prevention of mistaking the dosage of medicine.
- [Show abstract] [Hide abstract] ABSTRACT: Helicobacter pylori (H. pylori) is known to be associated with peptic ulcer, chronic gastritis, MALT lymphoma, and gastric cancer. In this study, we investigated the usefulness of a new E-plate serum antibody kit, developed in Japan using H. pylori strains isolated from Japanese patients, in the assessment of eradication, with an HM-CAP kit for comparison. The subjects were 100 H. pylori positive patients who underwent upper gastrointestinal endoscopy between October 1999 and June 2000. Eradication assessment performed using E-plate kit with the cut-off values for the delta value of the antibody titre set at -20%, -30%, and -40%, yielded sensitivity/specificity of 93.9%/85.7%, 92.4%/85.7%, and 72.7%/92.9%, respectively, for agreement rates with eradication assessments using endoscopic biopsy specimens at 2 months post-eradication therapy. Use of the HM-CAP kit with cut-off values of -5%, -10%, and -15% yielded sensitivity/specificity of 97.0%/28.6%, 83.3%/85.7%, and 53.0%/100%, respectively. These results indicated that the E-plate kit is more useful for eradication assessment in Japan.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Helicobacter pylori causes chronic gastritis and is also associated with many other gastrointestinal diseases. The incidence of gastric cancer is thought to vary according to the degree and topography of chronic gastritis. Histological findings of specimens obtained at endoscopy are therefore important. In the present study, we investigated the correlation between these histological findings and serum pepsinogen (PG) levels. Methods: Helicobacter pylori eradication therapy was conducted in 100 H. pylori-positive patients. Endoscopies were performed prior to, and 2 months after, eradication therapy; gastric mucosal biopsies were taken from the antrum and corpus. Helicobacter pylori infection was diagnosed using the rapid urease test, culture and histology. Using the Updated Sydney System, histological findings of inflammation, activity, atrophy and intestinal metaplasia were each graded. Blood was taken on the same two occasions for determination of serum levels of PG I and II. Results: Levels of PG I were highest in association with antrum-predominant gastritis (APG), followed in order by pangastritis (PAN) and corpus-predominant gastritis (CPG), with a significant difference between APG and CPG. No correlations were seen between PG II levels and gastritis topography. Examination of the relationship between PG levels and histological findings revealed significant correlations between PG I levels after eradication atrophy and intestinal metaplasia in the gastric corpus. No significant correlations were seen between PG II levels and before or after eradication histological findings. Conclusion: Our results indicate that serum PG levels may be a useful indicator of before-eradication gastritis topography and after-eradication gastric atrophy in the gastric corpus.
- [Show abstract] [Hide abstract] ABSTRACT: A 65-year old women visited our hospital for further examination of gastric ulcer lesion. Upper gastrointestinal endoscopy revealed multiple irregular ulcer lesions in the lesser curvature of anglus. Histological examination of biopsy specimens demonstrated diffuse infiltration centrocyte-like cells and formed lymphoepithelial lesions. Helicobacter pylori (H. pylori) was demonstrated by rapid urease test, culture and histological examination. Low grade mucosa-assiciated lymphoid tissue (MALT) lymphoma (stageI) with H. pylori was diagnosis by further examination of endoscopic ultrasonography, Computer tomography and 67Ga scintigraphy. One week eradication therapy (lansoprazole 60mg/day + Amoxicillin (AMPC) 1,500mg/day + clarithromycin (CAM) 800mg/day) unsuccessfully carried out and MALT lymphoma cells were remained. H. pylori strain separated from gastric mucosa after the first line eradication was reveled CAM-resistant strain by susceptibility test. Second line eradication (rabeprazole 20mg/day + AMPC 1,500mg/day + metronidazole 750mg/day 1wk) was carried out successfully and the lesion was regressed endoscopically and histologically.
Tokyo Medical University
Edo, Tōkyō, Japan
- Department of Gastroenterology and Hepatology
Tokyo University of Pharmacy and Life ScienceEdo, Tokyo, Japan