Ryota Hokari's research while affiliated with National Defense Medical College and other places
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Publications (369)
Luminal antigens, nutrients, metabolites from commensal bacteria, bile acids, or neuropeptides influence the function and trafficking of immune cells in the intestine. Among the immune cells in the gut, innate lymphoid cells, including macrophages, neutrophils, dendritic cells, mast cells, and innate lymphoid cells, play an important role for the m...
Background
Nonsteroidal anti-inflammatory drug (NSAID)-induced enteropathy, the mechanism of which is involved in oxidative stress, can be lethal due to hemorrhage. Thus, we aimed to investigate the effect of hydrogen-rich water (HRW), in terms of oxidative stress, on intestinal mucosal damage as well as changes in the gut microbiome and the short-...
Background and aim:
The study of the impact of environmental factors during pregnancy on fetal development has so far been focused primarily on the those negatively affecting human health; however, little is known about the effects of probiotic treatment during pregnancy on inflammatory bowel diseases (IBD). In this study, we investigated whether...
Background
The interleukin (IL)-23/Th17 pathway plays a critical role in ulcerative colitis (UC). The IL-12p40 subunit, which is shared by IL-23 and IL-12, is encoded by the IL12B gene. The current case-control study investigated the association between IL12B SNP rs6887695 and the UC risk.
Methods
There were 384 cases within 4 years of UC diagnosi...
Introduction:
The functions of basophils have not been elucidated until recently because of their rarity. However, with recent developments in basophil-specific antibodies and basophil-deficient animals, the roles of basophils in various diseases related to chronic inflammation have been clarified. In this study, we aimed to investigate the roles...
Endoscopic images and clinical description of steroid-resistant / refractory / intolerant CCS cases are shown in this chapter (11 cases).
In this chapter, comparison of pathological and endoscopic images of polyps or mucosal changes is shown. Polyps observed in CCS are classified as non-neoplastic. The glandular ducts are unequally sized, irregularly branched, and dilated, and may show the appearance of serrated changes. In cases with endoscopically white mucus adhered appearance, th...
In CCS, multiple polyps are found in the gastrointestinal tract mainly in the stomach and colon. Representative endoscopic images of polyps and mucosal change are shown in this chapter. Typical gastric polyps are described as “red cavir like,” which is characterized by findings of dense distribution of small hemispheric, edematous, and erythematous...
CCS might be easily suspected based on the findings of white light observation. However, a combination of small bowel endoscopy and image-enhanced endoscopy with high magnification can provide a more detailed picture of the disease. Representative endoscopic images of CCS observed by these newly developed endoscopy are shown in this chapter.
Endoscopic images and clinical description of CCS cases with atypical clinical symptoms or possible cases are shown in this chapter (17 cases).
Endoscopic images and clinical description of CCS cases with coincident esophageal legions or coincident tumor are shown in this chapter (16 cases).
Endoscopic images and clinical description of CCS cases suffering from first attack are shown in this chapter (23 cases).
Cronkhite–Canada Syndrome (CCS) is a non-hereditary disorder characterized by multiple non-neoplastic polyps in the gastrointestinal tract. CCS is considered to be a rare disease worldwide, but the majority of reported cases are from Japan. Polyps are frequently detected particularly in the stomach and colon, and in more than half of cases, polyps...
Endoscopic images and clinical description of relapse-remitting cases and chronic continuous cases are shown in this chapter (17cases).
Coincident carcinoma and adenoma are not rare in CCS. Thus, it is very important to pick up them from multiple polyps. NBI and BLI are both techniques that allow detailed observation of glandular and microvascular structures. Case reports using NBI have shown that many inflammatory hyperplastic polyps do not have abnormal microvasculature on their...
Endoscopic images and clinical description of CCS cases treated with other than corticosteroids are shown in this chapter (4 cases).
Immunoglobulin (Ig)G4-related disease (IgG4-RD) is a systemic condition associated with fibroinflammatory lesions and is characterized by elevated serum IgG4 levels and IgG4-positive cell infiltration into the affected tissues. It has been reported that IgG4-RD affects a variety of organs but uncommonly affects the gastrointestinal tract. In partic...
Hepatic portal venous gas (HPVG) is considered to be a sign of poor prognosis in abdominal diseases and a potentially fatal condition. However, HPVG after colonic endoscopic submucosal dissection (ESD), is an even rarer complication that there is just one report of it at the moment. In this report, we present a case of HPVG and bacteremia that happ...
Background
AJM300 is an oral, small-molecule α4-integrin antagonist. We assessed the efficacy and safety of AJM300 in patients with moderately active ulcerative colitis.
Methods
This multicentre, randomised, double-blind, placebo-controlled, phase 3 study consisted of two phases: a treatment phase and an open-label re-treatment phase. The study wa...
Background
The spread of coronavirus disease 2019 (COVID-19) had a major impact on the health of people worldwide. The clinical background and clinical course of inflammatory bowel disease (IBD) among Japanese patients with COVID-19 remains unclear.
Methods
This study is an observational cohort of Japanese IBD patients diagnosed with COVID-19. Dat...
A 78-year-old man presented to our hospital with a history of 10kg weight loss within 6 months previously, and general fatigue and fever for 2 and 1 months, respectively. On hospitalization, the patient was diagnosed with polyarteritis nodosa after multiple microaneurysms were observed in the liver, kidney, pancreas, and mesenteries. He achieved re...
The lymphatic vasculature returns filtered interstitial arterial fluid and tissue metabolites to the blood circulation. It also plays a major role in lipid absorption and immune cell trafficking. Lymphatic vascular defects have been revealed in inflammatory diseases, Crohn’s disease, obesity, cardiovascular disease, hypertension, atherosclerosis, a...
Background and Aim
Although an inverse relationship between current smoking and the development of ulcerative colitis (UC) has been shown in North America and Europe, evidence is limited in Asian countries, where the incidence of UC is rapidly increasing. This Japanese case-control study examined the association between active and passive smoking a...
Takayasu arteritis (TA) sometimes presents with colitis, which may be diagnosed as inflammatory bowel disease unclassified (IBDU) because of atypical or mixed findings of ulcerative colitis (UC) and Crohn's disease. We herein report an 18-year-old girl presenting with colitis with an occasional high fever eventually diagnosed as TA with IBDU. Colon...
Background and Aims
The artificial sweetener acesulfame potassium (ACK) is officially approved as safe for intake and has been used in processed foods. However, ACKs have been reported to induce metabolic syndrome, along with alteration of the gut microbiota in mice. In recent years, studies have suggested that this artificial sweetener promotes my...
Background:
Yeasts are a type of fungi thought to have probiotic functions. In this study, we isolated a novel probiotic yeast (Zygosaccharomyces sapae strain I-6) from Miso (a traditional Japanese fermented food). We examined its effects on phenotypic changes in intestinal dendritic cells (DCs), and evaluated its anti-inflammatory effects in dext...
A man in his 40s with a history of hospitalization for acute exacerbation of chronic pancreatitis presented with dyspnea. Chest radiography revealed left pleural effusion, and he was hospitalized for further evaluation and treatment. Thoracentesis was performed, and we suspected pancreatic pleural effusion based on high pancreatic enzyme levels in...
Objective: Oxidative stress is considered to be one of the etiologic factors involved in ulcerative colitis (UC), yet there is limited epidemiological information regarding the relationship between antioxidant intake and the risk of UC. The aim of the present case–control study in Japan was to examine the association between intake of green and yel...
Background
Anti-tumour necrosis factor (TNF) agents are the mainstay of long-term treatment for refractory ulcerative colitis. However, long-term use of anti-TNF therapy might lead to an increased risk of malignancy or infection. To date, no randomised controlled trial has evaluated whether anti-TNF agents can be safely discontinued in patients wit...
Background
The small intestine plays a central role in gut immunity, and enhanced lymphocyte migration is involved in the pathophysiology of various enteropathy. Bile acid (BA) is closely related to lipid metabolism and gut microbiota, and essential for gut homeostasis. However, the effects of BA on gut immunity have not been studied in detail, esp...
Introduction
Innate lymphoid cells (ILCs) are abundant in the intestinal mucosa, forming boundaries externally. Herein, ILCs were directly obtained from intestinal lymph using a lymph fistula rat model and analyzed under physiological and pathological conditions.
Methods
Thoracic duct (TD) lymphocytes were collected by cannulation with/without pre...
Background
Uric acid (UA) has anti- and pro-inflammatory properties. We previously revealed that elevated serum UA levels provide protection against murine small intestinal injury probably via luminal UA secreted in the small intestine. Luminal UA may act as an antioxidant, preventing microbiota vulnerability to oxidative stress. However, whether l...
Managing irritable bowel syndrome (IBS) has attracted international attention because single-agent therapy rarely relieves bothersome symptoms for all patients. The Japanese Society of Gastroenterology (JSGE) published the first edition of evidence-based clinical practice guidelines for IBS in 2015.
Much more evidence has accumulated since then, an...
Background
Adherence to medications is important to maintain disease under control and to prevent complications in pregnant patients with ulcerative colitis (UC). To evaluate the incidence of non-adherence during pregnancy and its effect on relapse and pregnancy outcomes, we conducted a multicenter prospective study using a patient self-reporting s...
Background
Some patients with inflammatory bowel disease (IBD) who were under mesalamine treatment develop adverse reactions called “mesalamine allergy,” which includes high fever and worsening diarrhea. Currently, there is no method to predict mesalamine allergy. Pharmacogenomic approaches may help identify these patients. Here we analyzed the gen...
Purpose
Assessment of liver fibrosis is essential for the management of liver disease. Although liver biopsy is the gold-standard modality for the diagnosis of liver fibrosis, it has some limitations. Thus, other methods are required to overcome the disadvantages of a liver biopsy. T1ρ magnetic resonance imaging (MRI) values are potential biomarker...
A 70-year-old asymptomatic man presented with a growing submucosal tumor in the duodenal bulb; and despite two EUS-FNA procedures, a diagnosis could not be confirmed. Since the mass was stalked and enlarged to 40 mm in size, the patient underwent endoscopic resection with grasping scissor forceps, while traction was applied for diagnostic treatment...
Aim
We recently reported that lipoprotein lipase (LPL)‐mediated free cholesterol (FC) accumulation in hepatic stellate cells (HSCs) augmented liver fibrosis in nonalcoholic steatohepatitis (NASH). The aim of the present study was to explore the role of angiopoietin‐like protein 4 (Angptl4), an LPL inhibitor, in the pathogenesis of liver fibrosis in...
Introduction
Worldwide increasing aging societies have many elderlies with intractable diseases including ulcerative colitis (UC). Reportedly, each patients’ frailty as well as chronological age is a clinical risk factor of elderly‐onset UC (EOUC). Since malnutrition is one of the major manifestations of frailty, we aimed to investigate the effect...
Background and Aim
Very early‐onset inflammatory bowel disease is defined as inflammatory bowel disease diagnosed before 6 years of age. Very early‐onset inflammatory bowel disease has various differential diagnoses, including primary immunodeficiency disorders, and is known to be resistant to conventional treatment. Therefore, global attention is...
The nuclear receptor peroxisome proliferator-activated receptor (PPAR)γ has been implicated in the pathogenesis of various human diseases including fatty liver. Although nuclear translocation of PPARγ plays an important role in PPARγ signaling, details of the translocation mechanisms have not been elucidated. Here we demonstrate that PPARγ2 translo...
A 69-year-old man had been intermittently experiencing abdominal pain from his 30s and was diagnosed with colonic diverticulitis. He further experienced right lower abdominal pain and received treatment. However, his condition did not improve, and he was referred to the National Defense Medical College Hospital. His abdominal pain episodes continue...
Background
The genetic variants of NUDT15 have been verified to induce adverse events (AEs) of thiopurines. Codon 139 variants are frequently observed in Asians, while multiple variants are seen in codon 18 which also cause AEs including the European ancestry. The purpose of this study is to establish a technique capable of the simple genotyping of...
Management of elderly ulcerative colitis in Japan
Background & aims:
We compared the diagnostic accuracy of the fecal calprotectin (FCP) test vs the fecal immunochemical blood test (FIT) in determining the endoscopic severity and predicting outcomes of patients with ulcerative colitis (UC).
Methods:
We performed a nationwide study of 879 patients with UC, enrolled at medical centers across Japa...
Objective:
Dietary emulsifiers are widely used in processed foods and officially approved as safe for intake. However, recent studies have demonstrated that some emulsifiers alter the colonic microbiota, leading to colonic low-grade inflammation, in mice. The effect of dietary emulsifiers on small-intestinal microbiota, which is important for gut...
A 20-year-old man presented to our department with hematemesis and odynophagia. The patient had been in his usual state of health before this presentation. Esophagogastroduodenoscopy (EGD) revealed multiple ulcer scars in the esophagus. EGD findings suggested Herpes esophagitis (HE). Endoscopic biopsy specimens were obtained from esophagus, stomach...
Background
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe procedure and extraintestinal bleeding after EUS-FNA is rare. Two cases of biliary tract bleeding after EUS-FNA was reported, but no case of biliary hemorrhage with obstructive jaundice after EUS-FNA of pancreatic head tumor has been reported. We discuss one such cas...
Lipoprotein lipase (LPL) plays a central role in incorporating plasma lipids into tissues and regulates lipid metabolism and energy balance in the human body. Conversely, LPL expression is almost absent in normal adult livers. Therefore, its physiological role in the liver remains unknown. We aimed to elucidate the role of LPL in the pathophysiolog...
Aim:
Chitinase 3-like 1 (CHI3L1), an 18-glycosyl hydrolase-related molecule, is a member of the enzymatically inactive chitinase-like-protein family. Serum levels of CHI3L1 are strongly correlated with hepatic fibrosis progression during many liver diseases. Therefore, this protein could be involved in the development of hepatic fibrosis pathology...
Japan has the largest aging society, where many elderly people have intractable diseases including ulcerative colitis (UC). Along with the increasing total number of UC patients, the number of elderly UC patients has also been increasing and will continue to do so in the future. Although the clinical features and natural history of UC in the elderl...
We herein present the case of an immunocompetent 63-year-old man who had previously undergone resection of Crohn's disease (CD)-related small intestinal obstruction more than 30 years ago. He had not been receiving any medication for many years, but had recently started to suffer from ileus. A stenosed site of ileo-cecal anastomosis was identified...
We herein report a 44-year-old man suffering from systemic edema due to protein-losing enteropathy (PLE) with superior mesenteric vein (SMV) obstruction and development of collateral veins, which subsequently proved to be a chronic result of thrombosis and a complication of Crohn's disease (CD). PLE was supposedly induced by both intestinal erosion...
Background
The introduction of the western diet has been proposed as an explanation for the increase in inflammatory bowel disease (IBD) incidence. Among them, greater consumption of fat is known to increase risk of IBD. We have reported that dietary fat augmented intestinal immune system by increasing lymphocyte migration to the intestinal microve...
Lymph nodes are the organs where an acquired immune response takes place rapidly (after infection) under the influence of antigen-presenting cells such as dendritic cells. Because the chance to encounter foreign antigens for each lymphocyte is quite small, lymphocytes keep moving through the whole body until they encounter a matching antigen-presen...