BACKGROUND Helicobacter pylori(H.pylori)infection is a risk factor for many diseases,including peptic ulcer disease and gastric cancer.While H.pylori eradication therapy can prevent these diseases,potentially unfavora...BACKGROUND Helicobacter pylori(H.pylori)infection is a risk factor for many diseases,including peptic ulcer disease and gastric cancer.While H.pylori eradication therapy can prevent these diseases,potentially unfavorable effects of eradication therapy have also been reported in some diseases,such as gastroesophageal reflux disease(GERD),Barrett’s esophagus(BE),inflammatory bowel disease(IBD),allergic diseases,and metabolic diseases.Consequently,both positive and negative impacts should be considered when assessing the effects of H.pylori eradication therapy.AIM To compare the incidence of these diseases before and after H.pylori eradication and to comprehensively assess its effects.METHODS This retrospective cohort study used a Japanese nationwide health claims database(April 2009-March 2020),developed by the Japanese Ministry of Health,Labour and Welfare.The database contained almost all health insurance claims data issued in Japan,and specific health check-up data for individuals who took the check-ups.Descriptive statistics were used for the analyses.Patients who received primary eradication therapy were defined as those prescribed medication for H.pylori eradication.New diagnoses,defined as incidence of upper gastrointestinal diseases and IBD,and prevalence of allergic diseases were compared before and after eradication.The incidence and prevalence of each disease were also compared between the 3-year period before eradication(from the 4th to the 2nd year prior to the year of eradication)and the 3-year period after eradication(from the 1st to the 3rd year after the year of eradication)based on the age category and calendar year and month.Changes in body mass index and proportion of patients with metabolic syndrome(MS)were examined before and after eradication.RESULTS We identified 5219731 patients who received primary eradication therapy.The 65-69 years age group had the greatest number of patients in both sexes.There was no significant increase in the incidence of GERD after eradication when considering the effects of aging and reporting period.However,the incidence of BE was higher in the 3-year period after eradication than in the 3-year period before eradication for all age categories(0.02%-0.10%vs<0.01%-0.05%).The incidence of IBD and prevalence of allergic disease were also higher after eradication.In contrast,the incidence of gastric and duodenal ulcers and gastritis was reduced after eradication.In patients with at least one entry of health check-up data(1701111 patients),the percentage of patients with MS showed a slight increase following eradication(11.0%in the year of eradication and 12.2%after 5 years).CONCLUSION The results suggest that H.pylori eradication therapy reduces peptic ulcers and gastritis;however,it is associated with increased incidence of several other chronic diseases.展开更多
The accurate diagnosis of extrahepatic bile duct carcinoma is difficult,even now.When ultrasonography(US)shows dilatation of the bile duct,magnetic resonance cholangiopancreatography followed by endoscopic US(EUS)is t...The accurate diagnosis of extrahepatic bile duct carcinoma is difficult,even now.When ultrasonography(US)shows dilatation of the bile duct,magnetic resonance cholangiopancreatography followed by endoscopic US(EUS)is the next step.When US or EUS shows localized bile duct wall thickening,endoscopic retrograde cholangiopancreatography should be conducted with intraductal US(IDUS)and forceps biopsy.Fluorescence in situ hybridization increases the sensitivity of brush cytology with similar specificity.In patients with papillary type bile duct carcinoma,three biopsies are sufficient.In patients with nodular or infiltrating-type bile duct carcinoma,multiple biopsies are warranted,and IDUS can compensate for the limitations of biopsies.In preoperative staging,the combination of dynamic multidetector low computed tomography(MDCT)and IDUS is useful for evaluating vascular invasion and cancer depth infiltration.However,assessment of lymph nodes metastases is difficult.In resectable cases,assessment of longitudinal cancer spread is important.The combination of IDUS and MDCT is useful for revealing submucosal cancer extension,which is common in hilar cholangiocarcinoma.To estimate the mucosal extenextension,which is common in extrahepatic bile duct carcinoma,the combination of IDUS and cholangioscopy is required.The utility of current peroral cholangioscopy is limited by the maneuverability of the“baby scope”.A new baby scope(10 Fr),called“SpyGlass”has potential,if the image quality can be improved.Since extrahepatic bile duct carcinoma is common in the Far East,many researchers in Japan and Korea contributed these studies,especially,in the evaluation of longitudinal cancer extension.展开更多
The demarcation line between the cancerous lesion and the surrounding area could be easily recognized with flexible spectral imaging color enhancement (FICE) system compared with conventional white light images. The c...The demarcation line between the cancerous lesion and the surrounding area could be easily recognized with flexible spectral imaging color enhancement (FICE) system compared with conventional white light images. The characteristic f inding of depressed-type early gastric cancer (EGC) in most cases was revealed as reddish lesions distinct from the surrounding yellowish non-cancerous area without magnification. Conventional endoscopic images provide little information regarding depressed lesions located in the tangential line, but FICE produces higher color contrast of such cancers. Histological f indings in depressed area with reddish col- or changes show a high density of glandular structure and an apparently irregular microvessel in intervening parts between crypts, resulting in the higher color con- trast of FICE image between cancer and surrounding area. Some depressed cancers are shown as whitish lesion by conventional endoscopy. FICE also can pro- duce higher color contrast between whitish cancerous lesions and surrounding atrophic mucosa. For nearly flat cancer, FICE can produce an irregular structuralpattern of cancer distinct from that of the surrounding mucosa, leading to a clear demarcation. Most elevated-type EGCs are detected easily as yellowish lesions with clearly contrasting demarcation. In some cases, a partially reddish change is accompanied on the tumor surface similar to depressed type cancer. In addition, the FICE system is quite useful for the detection of minute gastric cancer, even without magnif ication. These new contrasting images with the FICE system may have the potential to increase the rate of detection of gastric cancers and screen for them more effectively as well as to determine the extent of EGC.展开更多
AIM: To clarify clinical features of the NSAID-induced small bowel lesions using a new method of endoscopy.METHODS: This is a retrospective study and we analyzed seven patients with small bowel lesions while taking NS...AIM: To clarify clinical features of the NSAID-induced small bowel lesions using a new method of endoscopy.METHODS: This is a retrospective study and we analyzed seven patients with small bowel lesions while taking NSAIDs among 61 patients who had undergone doubleballoon endoscopy because of gastro-intestinal bleeding or anemia between September 2000 and March 2004, at Jichi Medical School Hospital in Japan. Neither conventional EGD nor colonoscopy revealed any lesions of potential bleeding sources including ulcerations. Double-balloon endoscopy was carried out from oral approach in three patients, from anal approach in three patients, and from both approaches in one patient.RESULTS: Ulcers or erosions were observed in the ileum in six patients and in the jejunum in one patient, respectively.The ulcers were multiple in all the patients with different features from tiny punched out ulcers to deep ulcerations with oozing hemorrhage or scar. All the patients recovered uneventfully and had full resolution of symptoms after suspension of the drug.CONCLUSION: NSAIDs can induce injuries in the small bowel even in patients without any lesions in both the stomach and colon.展开更多
AIM: To evaluate the clinical outcome of enteroscopy, using the double-balloon method, focusing on the involvement of neoplasms in strictures of the small intestine.METHODS: Enteroscopy, using the double-balloon metho...AIM: To evaluate the clinical outcome of enteroscopy, using the double-balloon method, focusing on the involvement of neoplasms in strictures of the small intestine.METHODS: Enteroscopy, using the double-balloon method, was performed between December 1999 and December 2002 at Jichi Medical School Hospital, Japan and strictures of the small intestine were found in 17 out of 62 patients. These 17 consecutive patients were subjected to analysis.RESULTS: The double-balloon enteroscopy contributed to the diagnosis of small intestinal neoplasms found in 3out of 17 patients by direct observation of the strictures as well as biopsy sampling. Surgical procedures were chosen for these three patients, while balloon dilation was chosen for the strictures in four patients diagnosed with inflammation without involvement of neoplasm.CONCLUSION: Double-balloon enteroscopy is a useful method for the diagnosis and treatment of strictures in the small bowel.展开更多
基金The study was reviewed and approved for publication by the Ethics Committee of Oita University,Faculty of Medicine(No.1692).
文摘BACKGROUND Helicobacter pylori(H.pylori)infection is a risk factor for many diseases,including peptic ulcer disease and gastric cancer.While H.pylori eradication therapy can prevent these diseases,potentially unfavorable effects of eradication therapy have also been reported in some diseases,such as gastroesophageal reflux disease(GERD),Barrett’s esophagus(BE),inflammatory bowel disease(IBD),allergic diseases,and metabolic diseases.Consequently,both positive and negative impacts should be considered when assessing the effects of H.pylori eradication therapy.AIM To compare the incidence of these diseases before and after H.pylori eradication and to comprehensively assess its effects.METHODS This retrospective cohort study used a Japanese nationwide health claims database(April 2009-March 2020),developed by the Japanese Ministry of Health,Labour and Welfare.The database contained almost all health insurance claims data issued in Japan,and specific health check-up data for individuals who took the check-ups.Descriptive statistics were used for the analyses.Patients who received primary eradication therapy were defined as those prescribed medication for H.pylori eradication.New diagnoses,defined as incidence of upper gastrointestinal diseases and IBD,and prevalence of allergic diseases were compared before and after eradication.The incidence and prevalence of each disease were also compared between the 3-year period before eradication(from the 4th to the 2nd year prior to the year of eradication)and the 3-year period after eradication(from the 1st to the 3rd year after the year of eradication)based on the age category and calendar year and month.Changes in body mass index and proportion of patients with metabolic syndrome(MS)were examined before and after eradication.RESULTS We identified 5219731 patients who received primary eradication therapy.The 65-69 years age group had the greatest number of patients in both sexes.There was no significant increase in the incidence of GERD after eradication when considering the effects of aging and reporting period.However,the incidence of BE was higher in the 3-year period after eradication than in the 3-year period before eradication for all age categories(0.02%-0.10%vs<0.01%-0.05%).The incidence of IBD and prevalence of allergic disease were also higher after eradication.In contrast,the incidence of gastric and duodenal ulcers and gastritis was reduced after eradication.In patients with at least one entry of health check-up data(1701111 patients),the percentage of patients with MS showed a slight increase following eradication(11.0%in the year of eradication and 12.2%after 5 years).CONCLUSION The results suggest that H.pylori eradication therapy reduces peptic ulcers and gastritis;however,it is associated with increased incidence of several other chronic diseases.
文摘The accurate diagnosis of extrahepatic bile duct carcinoma is difficult,even now.When ultrasonography(US)shows dilatation of the bile duct,magnetic resonance cholangiopancreatography followed by endoscopic US(EUS)is the next step.When US or EUS shows localized bile duct wall thickening,endoscopic retrograde cholangiopancreatography should be conducted with intraductal US(IDUS)and forceps biopsy.Fluorescence in situ hybridization increases the sensitivity of brush cytology with similar specificity.In patients with papillary type bile duct carcinoma,three biopsies are sufficient.In patients with nodular or infiltrating-type bile duct carcinoma,multiple biopsies are warranted,and IDUS can compensate for the limitations of biopsies.In preoperative staging,the combination of dynamic multidetector low computed tomography(MDCT)and IDUS is useful for evaluating vascular invasion and cancer depth infiltration.However,assessment of lymph nodes metastases is difficult.In resectable cases,assessment of longitudinal cancer spread is important.The combination of IDUS and MDCT is useful for revealing submucosal cancer extension,which is common in hilar cholangiocarcinoma.To estimate the mucosal extenextension,which is common in extrahepatic bile duct carcinoma,the combination of IDUS and cholangioscopy is required.The utility of current peroral cholangioscopy is limited by the maneuverability of the“baby scope”.A new baby scope(10 Fr),called“SpyGlass”has potential,if the image quality can be improved.Since extrahepatic bile duct carcinoma is common in the Far East,many researchers in Japan and Korea contributed these studies,especially,in the evaluation of longitudinal cancer extension.
文摘The demarcation line between the cancerous lesion and the surrounding area could be easily recognized with flexible spectral imaging color enhancement (FICE) system compared with conventional white light images. The characteristic f inding of depressed-type early gastric cancer (EGC) in most cases was revealed as reddish lesions distinct from the surrounding yellowish non-cancerous area without magnification. Conventional endoscopic images provide little information regarding depressed lesions located in the tangential line, but FICE produces higher color contrast of such cancers. Histological f indings in depressed area with reddish col- or changes show a high density of glandular structure and an apparently irregular microvessel in intervening parts between crypts, resulting in the higher color con- trast of FICE image between cancer and surrounding area. Some depressed cancers are shown as whitish lesion by conventional endoscopy. FICE also can pro- duce higher color contrast between whitish cancerous lesions and surrounding atrophic mucosa. For nearly flat cancer, FICE can produce an irregular structuralpattern of cancer distinct from that of the surrounding mucosa, leading to a clear demarcation. Most elevated-type EGCs are detected easily as yellowish lesions with clearly contrasting demarcation. In some cases, a partially reddish change is accompanied on the tumor surface similar to depressed type cancer. In addition, the FICE system is quite useful for the detection of minute gastric cancer, even without magnif ication. These new contrasting images with the FICE system may have the potential to increase the rate of detection of gastric cancers and screen for them more effectively as well as to determine the extent of EGC.
文摘AIM: To clarify clinical features of the NSAID-induced small bowel lesions using a new method of endoscopy.METHODS: This is a retrospective study and we analyzed seven patients with small bowel lesions while taking NSAIDs among 61 patients who had undergone doubleballoon endoscopy because of gastro-intestinal bleeding or anemia between September 2000 and March 2004, at Jichi Medical School Hospital in Japan. Neither conventional EGD nor colonoscopy revealed any lesions of potential bleeding sources including ulcerations. Double-balloon endoscopy was carried out from oral approach in three patients, from anal approach in three patients, and from both approaches in one patient.RESULTS: Ulcers or erosions were observed in the ileum in six patients and in the jejunum in one patient, respectively.The ulcers were multiple in all the patients with different features from tiny punched out ulcers to deep ulcerations with oozing hemorrhage or scar. All the patients recovered uneventfully and had full resolution of symptoms after suspension of the drug.CONCLUSION: NSAIDs can induce injuries in the small bowel even in patients without any lesions in both the stomach and colon.
文摘AIM: To evaluate the clinical outcome of enteroscopy, using the double-balloon method, focusing on the involvement of neoplasms in strictures of the small intestine.METHODS: Enteroscopy, using the double-balloon method, was performed between December 1999 and December 2002 at Jichi Medical School Hospital, Japan and strictures of the small intestine were found in 17 out of 62 patients. These 17 consecutive patients were subjected to analysis.RESULTS: The double-balloon enteroscopy contributed to the diagnosis of small intestinal neoplasms found in 3out of 17 patients by direct observation of the strictures as well as biopsy sampling. Surgical procedures were chosen for these three patients, while balloon dilation was chosen for the strictures in four patients diagnosed with inflammation without involvement of neoplasm.CONCLUSION: Double-balloon enteroscopy is a useful method for the diagnosis and treatment of strictures in the small bowel.