記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We have determined that the impaired accommodation of the lower esophageal sphincter (LES) underlies the pathogenesis of esophagogastric junction outflow obstruction (EGJOO). We have also found that acotiamide may treat EGJOO by improving impaired LES accommodation. The effects of acotiamide in patients with EGJOO need to be further confirmed in a prospective study. METHODS: This trial is a multicenter, randomized, double-blind, placebo-controlled study to compare the efficacy and safety of acotiamide (300 mg/day or 600 mg/day) with those of a placebo in the treatment of patients with EGJOO. The primary endpoint will be the proportion of patients who report an improvement in symptom of food sticking in the chest after 4 weeks of treatment period 1. The secondary endpoints will be the proportion of patients with normalized integrated relaxation pressure (IRP), the value of change from baseline in the distal contractile integral, basal LES pressure, EGJOO-quality of life score, Gastrointestinal Symptom Rating Scale, and the correlation between IRP and each symptom score. During the 2-year trial period, 42 patients from five institutions will be enrolled. DISCUSSION: This trial will provide evidence to clarify the efficacy and safety of acotiamide as a treatment for patients with EGJOO. Acotiamide might help improve the quality of life of patients with EGJOO and is expected to prevent the progression of EGJOO to achalasia. TRIAL REGISTRATION: This study was approved by the Institutional Review Board (IRB) of Kyushu University Hospital as well as the local IRBs of the participating sites for clinical trials and registered in the Japan Registry of Clinical Trials (jRCT: 2071210072). The registration date is on October 11, 2021.

DOI： 10.1186/s13063-023-07468-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Esophageal hypersensitivity is associated with gastroesophageal reflux disease (GERD). Since sleep disturbance causes esophageal hypersensitivity, hypnotics may ameliorate GERD. However, zolpidem prolongs esophageal acid clearance. Lemborexant is a new hypnotic with higher efficacy and fewer adverse events than zolpidem. Therefore, the present study investigated the effects of lemborexant on GERD. METHODS: Patients with heartburn and/or regurgitation and insomnia who did not take acid suppressants or hypnotics in the last month were recruited. Symptom assessments using GerdQ and reflux monitoring were performed before and after a 28-day treatment with 5 mg lemborexant at bedtime. The primary outcome was a change in the total GerdQ score, excluding the score for insomnia. Secondary outcomes were changes in each GerdQ score and the following parameters on reflux monitoring: the acid exposure time (AET), number of reflux events (RE), acid clearance time (ACT), and post-reflux swallow-induced peristaltic wave (PSPW) index. RESULTS: Sixteen patients (age 45.0 [33.3-56.0], 11 females [68.8%]) completed the intervention (1 patient did not tolerate the second reflux monitoring). The total GerdQ score, excluding the score for insomnia, did not significantly change (8.0 [6.0-9.0] before vs. 7.0 [6.3-9.0] after p = 0.16). GerdQ showed the significant attenuation of regurgitation (2.0 [2.0-3.0] vs. 1.0 [0-2.8] p = 0.0054) but not heartburn (2.5 [1.0-3.0] vs. 1.0 [0.3-2.0] p = 0.175). No significant differences were observed in AET, RE, ACT, or PSPW index before and after the intervention. CONCLUSION: Lemborexant attenuated regurgitation without the worsening of objective reflux parameters. A randomized placebo-controlled study is warranted in the future.

DOI： 10.1159/000531412

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記述言語：日本語   出版者・発行元：(株)東京医学社  

2015年に強力な酸分泌抑制作用を有するカリウムイオン競合型アシッドブロッカー(potassium-competitive acid blocker:P-CAB)のボノプラザンが本邦で登場し,ボノプラザンの成績を含めたGERD診療における新たな知見データを加える必要が生じ,2021年に最新のガイドライン第3版が発刊された。今回のガイドライン改訂における重要臨床課題は,(1)逆流性食道炎とNERDに分けた治療のアルゴリズムの導入,(2)逆流性食道炎の重症度別の治療アルゴリズムの導入,(3)P-CABの胃食道逆流症(逆流性食道炎,NERD)治療への位置づけの3項目である。最新のガイドラインでは,重症逆流性食道炎に対してはボノプラザン20mg/日を4週間投与する初期治療とボノプラザン10mg/日による積極的な維持療法を提案している。軽症逆流性食道炎に対してはPPIとボノプラザンのいずれも食道粘膜傷害の治癒をもたらすためPPIとボノプラザンのどちらも初期治療として推奨し,維持療法はボノプラザンの長期投与の安全性情報が不十分であるためPPIを推奨,ボノプラザンを提案としている。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Saliva secretion in healthy subjects is lower in females than in males. The present study investigated sex differences in saliva secretion in patients with gastroesophageal reflux disease (GERD) and healthy controls. METHODS: This case-control study included 39 (male/female: 16/23) with non-erosive reflux disease (NERD), 49 (25/24) patients with mild reflux esophagitis, 45 (23/22) with severe reflux esophagitis (A1), and 46 (24/22) healthy controls. Saliva secretion was examined as follows: before endoscopy, patients chewed sugar-free gum for three minutes, and the amount and pH of saliva before and after acid loading as an index of acid-buffering capacity were evaluated. The relationships between saliva secretion and body mass index, height, and weight were also examined. RESULTS: The amount of saliva secreted was significantly lower in females than in males in all four groups (NERD, mild reflux esophagitis, severe reflux esophagitis, and healthy controls). Salivary pH and acid-buffering capacity were similar in all groups. The amount of saliva secreted positively correlated with height and body weight, albeit more strongly with height. CONCLUSION: A sex difference in saliva secretion exists in GERD patients, similar to healthy controls. Saliva secretion was significantly lower in female GERD patients than in male GERD patients.

DOI： 10.7759/cureus.39020

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記述言語：日本語   出版者・発行元：(株)東京医学社  

2015年に強力な酸分泌抑制作用を有するカリウムイオン競合型アシッドブロッカー(potassium-competitive acid blocker:P-CAB)のボノプラザンが本邦で登場し,ボノプラザンの成績を含めたGERD診療における新たな知見データを加える必要が生じ,2021年に最新のガイドライン第3版が発刊された。今回のガイドライン改訂における重要臨床課題は,(1)逆流性食道炎とNERDに分けた治療のアルゴリズムの導入,(2)逆流性食道炎の重症度別の治療アルゴリズムの導入,(3)P-CABの胃食道逆流症(逆流性食道炎,NERD)治療への位置づけの3項目である。最新のガイドラインでは,重症逆流性食道炎に対してはボノプラザン20mg/日を4週間投与する初期治療とボノプラザン10mg/日による積極的な維持療法を提案している。軽症逆流性食道炎に対してはPPIとボノプラザンのいずれも食道粘膜傷害の治癒をもたらすためPPIとボノプラザンのどちらも初期治療として推奨し,維持療法はボノプラザンの長期投与の安全性情報が不十分であるためPPIを推奨,ボノプラザンを提案としている。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

＜文献概要＞好酸球性食道炎(EoE)はアレルギー性消化管疾患の一つであり,本邦での診断基準は2010年に作成され2015年に改訂が行われた.2020年には「幼児・成人好酸球性消化管疾患診療ガイドライン」が発行されている.つかえ感や胸やけなどの症状を有し,食道粘膜生検で15個以上/HPFの好酸球浸潤を認めることが診断の必須条件となる.EoEは縦走溝,輪状溝,白色滲出物などの特徴的な内視鏡所見を呈することが多く,内視鏡検査時にこれらの所見を認めた場合はEoEの可能性が高く積極的な生検が望まれる.確定診断には逆流性食道炎や他の好酸球増多疾患を除外する必要がある.EoEはさまざまな食道運動異常を呈することがあり,食道の異常強収縮をきたすhypercontractile(Jackhammer) esophagusの一部では食道筋層のみに好酸球浸潤を認めることがあり,好酸球性食道筋炎と呼ぶ新たな概念も提唱されている.

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：英語  

A 78-year-old man was admitted to our hospital with a tarry stool. Esophagogastroduodenoscopy identified tiny oozing on the greater curvature at the antrum. Despite repeated endoscopic hemostasis by coagulation and clipping, rebleeding occurred. On the third rebleeding, we performed endoscopic hand suturing to completely close the ulcer surface. Biopsy showing massive infiltration of eosinophils at the ulcer edge indicated eosinophilic gastritis. After the endoscopic closure by endoscopic hand suturing, the patient had no symptoms of bleeding thereafter and was discharged 19 days after the procedure by taking oral prednisolone. The patient remained well and was continuously treated with a small dose of steroids in outpatient. This is the first case report of the successful application of endoscopic hand suturing to a refractory hemorrhagic ulcer. Further accumulation of clinical experiences is desired to confirm the usefulness of this technique for the prevention of refractory ulcer bleeding.

DOI： 10.1002/deo2.207

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Sex differences in salivary secretion have been reported among healthy subjects. In the present study, salivary secretion and salivary epidermal growth factor (EGF) concentrations were investigated in mild reflux esophagitis patients, non-erosive reflux disease (NERD) patients, and healthy controls by matching the sex ratio. METHODS: Thirty-three (male:female = 11:22) patients with NERD, 33 (11:22) with mild reflux esophagitis, and 33 (11:22) healthy controls were recruited for this case-control study. Salivary secretion was assessed as follows: each patient chewed sugar-free gum for 3 min prior to endoscopy, and the amount of saliva secretion, salivary pH, and salivary pH after acid loading as an index of the acid-buffering capacity were measured. Salivary EGF concentrations were measured by ELISA. RESULTS: No significant differences were observed in the amount of saliva secretion, salivary pH, or the acid-buffering capacity between the mild reflux esophagitis and NERD groups. However, the amount of saliva secretion and the acid-buffering capacity in the mild reflux esophagitis group and the amount of saliva secretion, salivary pH, and the acid-buffering capacity in the NERD group were significantly lower than those in the healthy control group. No significant differences were noted in salivary EGF concentrations between the mild reflux esophagitis and NERD groups. CONCLUSION: After matching the sex ratio, the saliva secretion was significantly lower in patients with mild reflux esophagitis and NERD than in healthy controls. However, no significant differences were observed in the amount of saliva secretion or salivary EGF concentrations between both groups.

DOI： 10.1007/s10388-022-00966-x

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This study was performed to evaluate the orientation of lower esophageal sphincter (LES) pressure in patients with untreated achalasia using three-dimensional high-resolutionmanometry (3D-HRM). METHODS: The study involved 20 patients with untreated achalasia (10 men, 60 [47-74] years of age). The 3D-HRM assembly had 32 standard channels and 12 3D channels. During basal LES pressure measurements, the orientations of the LES high- and low-pressure zones were evaluated at end-expiration. The directional relationships between the orientation of the LES high- and low-pressure zones were also evaluated. RESULTS: The LES high-pressure zones were located on the greater curvature side in nine (45%) patients, from the greater curvature to posterior wall side in six (30%), and from the greater curvature to anterior wall side in five (25%). The LES high-pressure zones were located mainly on the greater curvature side, but there were some variations of the orientation among the patients. The LES low-pressure zones were most frequently located from the lesser curvature to the posterior wall side in 11 (55%) patients, from the lesser curvature to anterior wall side in 6 (30%), on the posterior wall side in 2 (10%), and on the anterior wall side in 1 (5%). Significant differences were found in the directional relationships between the orientation of the LES high- and low-pressure zones (P = 0.0053). CONCLUSIONS: This is the first report from Japan focusing on the LES pressure orientation using 3D-HRM. Such evaluation may be useful for clarifying the pathophysiology of achalasia.

DOI： 10.1272/jnms.JNMS.2023_90-203

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Saliva secretion is significantly lower in patients with mild reflux esophagitis than in healthy controls. A previous study on healthy controls showed that stimulated saliva secretion was lower in females than in males. Saliva secretion may be lower in female patients with mild reflux esophagitis than in male patients. Therefore, the present study investigated sex differences in saliva secretion in patients with mild reflux esophagitis. METHODS: Twenty-five male patients with mild reflux esophagitis, 25 male healthy controls, 24 female patients with mild reflux esophagitis, and 24 female healthy controls were recruited for this case-control study. Saliva secretion was assessed as follows: each patient chewed sugar-free gum for 3 minutes prior to endoscopy, and the volume and pH of saliva before and after acid loading as an index of the acid-buffering capacity were measured. RESULTS: No significant differences were observed in the amount of stimulated saliva secretion, salivary pH, or the acid-buffering capacity between male patients with mild reflux esophagitis and healthy controls. No significant differences were noted in salivary pH between female patients with mild reflux esophagitis and healthy controls; however, the amount of stimulated saliva secretion was significantly lower (p = 0.0023) in the former (2.5 [1.9-4.1]) than in the latter (4.6 [3.2-6.6]), while the acid-buffering capacity was slightly lower (p = 0.0578) in the former (5.9 [5.7-6.2]) than in the latter (6.2 [6.0-6.5]). CONCLUSION: The amount of stimulated saliva secretion was significantly lower in female patients with mild reflux esophagitis than in female healthy controls. This reduction in saliva secretion may affect the pathophysiology of mild reflux esophagitis in females.

DOI： 10.1159/000528863

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The secretion of saliva, which is triggered by acid reflux into the esophagus via the esophagosalivary reflex, plays a crucial role in the defensive mechanisms of the esophagus. The volume of saliva secreted in patients with gastroesophageal reflux disease (GERD) is reduced. However, the effects of proton pump inhibitors (PPI) on the secretion of saliva have rarely been reported. Therefore, the present study investigated changes in the volume and pH of saliva after the cessation of PPI. MATERIALS AND METHODS: We retrospectively reviewed the records of consecutive patients previously diagnosed with mild reflux esophagitis (RE) or non-erosive reflux disease (NERD) controlled with PPI (including vonoprazan) who performed the salivary secretion test before and after a 2-week cessation of PPI. The volume, pH, and pH after acid loading (buffering capacity) of saliva were compared before and after the cessation of PPI. RESULTS: Thirty-two patients (25 NERD, 7 mild RE) were included. The second saliva test was performed a median interval of 14 months [12.0-15.3] after the first test. No significant differences were observed in the volume of saliva secreted before and after the cessation of PPI (before 4.0 mL [2.7-6.0] vs. after 4.0 mL [2.3-5.9], p = 0.894). No significant differences were noted in pH or changes in pH after acid loading before and after the cessation of PPI (pH: before 7.1 ± 0.24 vs. after 7.0 ± 0.24, p = 0.1. Delta pH after acid loading: before 1.0 [0.8-1.2] vs. after 1.0 [0.8-1.2], p = 0.844). CONCLUSION: The cessation of PPI did not appear to affect the volume, pH, or buffering capacity of saliva in patients with PPI-responsive mild RE and NERD.

DOI： 10.1159/000528086

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIM: Discrepancies have been reported in the circumferential locations of mild mucosal breaks. We investigated their locations using a new method. METHODS: This is a retrospective study. Eighty patients (Grade A/B: 53/27) with mild mucosal breaks in the lower esophagus were examined. Since the 3 o'clock position corresponded to the right wall of the lower esophagus using our method with sufficient accuracy, the circumferential locations of mucosal breaks were identified as times on a clock face, which were changed to circular data to calculate the mean direction. The circumferential distribution of mucosal breaks was evaluated in the single lesion group (single group) and multiple lesion group (multiple group). RESULTS: Forty-eight of 80 patients had 1 mucosal break, while 32 had ≥2 mucosal breaks. Circumferential locations markedly differed between the single and multiple groups. In the single group, mucosal breaks were exclusively distributed between 2 and 7 o'clock, with 50% in the 3 o'clock direction (right wall). In the multiple group, 81 mucosal breaks were distributed circumferentially, not uniformly; however, at least 1 lesion was located between 2 and 7 o'clock in 91% of subjects. Therefore, a factor for the development of mucosal breaks from the right to posterior wall was present in both groups. CONCLUSION: In the single group, mucosal breaks were localized from the right to posterior wall, mainly in the right wall. In the multiple group, mucosal breaks were located circumferentially, but often between the right lateral and posterior wall. These two distributions significantly differed.Clinical trial registration: This is a retrospective study, so it was not registered.

DOI： 10.1002/jgh3.12834

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記述言語：日本語   出版者・発行元：日本臨床生理学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Chicago classification version 4.0 suggests additional maneuvers, such as upright testing, multiple rapid swallows (MRS), and the rapid drink challenge (RDC), for high-resolution manometry (HRM) to minimize ambiguity in the diagnosis of esophageal motility disorders. The present study investigated normative thresholds for these new metrics using the Starlet system as well as their diagnostic yields for relevant esophagogastric outflow disorders (EGJOD). METHODS: In study 1, 30 asymptomatic volunteers prospectively performed HRM including MRS and RDC in the supine/upright positions. We calculated normative thresholds for the new metrics, such as upright integrated relaxation pressure (IRP), upright intrabolus pressure (IBP), and IRP during RDC (RDC-IRP). In study 2, we retrospectively analyzed the HRM tracings of 82 patients who underwent HRM in both positions at our hospital to assess the diagnostic yields of HRM metrics. RESULTS: Based on the results of study 1, we adopted the following normative thresholds: upright IRP < 20 mmHg, upright IBP < 21 mmHg, and RDC-IRP < 16 mmHg. In study 2, 45 patients with dysphagia or chest pain were included in the analysis to identify predictive factors for clinically relevant esophagogastric outflow disorders (true EGJOD). Supine/upright IRP, RDC-IRP, and pan-esophageal pressurization > 20 mmHg during RDC (RDC-PEP) predicted true EGJOD with RDC-PEP with the highest sensitivity of 91.7%. CONCLUSIONS: HRM with additional maneuvers may facilitate the diagnosis of clinically relevant EGJOD.

DOI： 10.1007/s10388-022-00956-z

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Jackhammer esophagus (JE) is a hypercontractile esophageal motility disorder diagnosed using high-resolution manometry (HRM). We sought to determine the clinical presentation and therapeutic data of patients with JE in Japan. METHODS: The study included patients with JE, diagnosed through HRM performed for suspicious esophageal motility disorders. Demographics, esophagogastroduodenoscopy, radiology, and therapy data were collected from patient charts. RESULTS: Among the 4,412 HRM tests performed, 89 patients (61.6 ± 13.4 years; 64 males, 25 females) were diagnosed with JE (2.0%). Dysphagia was the most frequent symptom (80%), followed by chest pain (40%) and heartburn (25%). Esophagogastroduodenoscopy showed abnormal findings in 32% of patients: corkscrew/rosary beads appearance in 26%, narrowing in 11%. Eosinophilic infiltration (> 15 eosinophils/high power field) was diagnosed in 21%. Esophagography showed abnormal findings in 9% of the patients. For the initial therapy, 47 patients received medical treatment followed by peroral endoscopic myotomy (21 patients) and laparoscopic myotomy (two patients). Thirteen patients did not receive any treatment and 10 of those (77%) reported spontaneous resolution of symptoms. Patients who required invasive treatment experienced severe disability in their quality of life and greater maximal distal contractile integral than those who did not. CONCLUSIONS: HRM showed that the prevalence of JE was very low (2%). Esophagogastroduodenoscopy revealed some characteristic features of JE in patients. Some patients showed improvement of symptoms without invasive treatments. Follow-up with/without medical treatment should be considered before performing invasive treatment in patients whose distal contractile integral is relatively low and the quality of life is not impaired.

DOI： 10.1007/s10388-022-00916-7

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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This study investigated potential determinants of reflux perception in patients with non-erosive reflux disease (NERD) who had reflux-related symptoms on potassium-competitive acid blocker (P-CAB) therapy. METHODS: This study included 23 patients with reflux-related symptoms despite P-CAB therapy. Esophageal impedance-pH monitoring was performed on P-CAB and the following potential determinants of reflux perception were investigated: reflux nadir pH value; change in pH (baseline-nadir); bolus clearance time; reflux extent; proportions of acid, weakly acidic, and weakly alkaline reflux episodes; and proportions of liquid and mixed reflux episodes. RESULTS: Overall, ≥ 90% of all and symptomatic reflux episodes were weakly acidic reflux and 63% of symptomatic reflux episodes were reflux episodes with pH ≥ 5. There were no significant differences regarding potential determinants between symptomatic and asymptomatic reflux episodes. However, the proportion of symptomatic reflux episodes was significantly greater with pH < 5 (13.8%) than with pH ≥ 5 (9.5%) (P = 0.0431). In reflux episodes with pH < 5, the proportion of symptomatic reflux episodes was significantly greater in proximal sites (20.6%) than in distal sites (10.6%) (P = 0.0178). Conversely, in reflux episodes with pH ≥ 5, there was no significant difference regarding reflux perception according to reflux extent (proximal: 9.6% vs. distal: 9.0%, P = 0.9337). CONCLUSIONS: In patients with P-CAB-resistant NERD, reflux symptoms were mainly caused by reflux episodes with pH ≥ 5 on P-CAB therapy. The proportions of symptomatic reflux episodes among reflux sites differed according to reflux pH value; thus, the mechanisms of reflux perception may differ according to reflux pH value.

DOI： 10.1007/s10388-021-00889-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The relationship between bothersome symptoms and gastric pressure or CO2 injection volumes in drug-resistant functional dyspepsia (FD) patients remains unknown; therefore, this relationship was examined in drug-resistant FD and non-FD patients. METHODS: Thirty drug-resistant FD patients and 30 non-FD patients were recruited. Gastric pressure was assessed using an external pressure transducer, and the CO2 injection volume was measured using an endoscopic CO2-supplied device and flow meter. The following variables were examined: gastric pressure at baseline and gastric pressure and the CO2 injection volume when patients initially felt abdominal tension and bothersome symptoms following the CO2 injection. The relationship between belching and bothersome symptoms was also investigated. RESULTS: No significant differences were observed in basal gastric pressure between the groups. Initial and bothersome symptoms in the upper abdomen in drug-resistant FD patients developed at a significantly lower gastric pressure and significantly smaller CO2 injection volume than in non-FD patients. The frequency of belching was significantly lower in the drug-resistant FD group than in the non-FD group. CONCLUSION: Bothersome symptoms in drug-resistant FD patients develop at a lower gastric pressure and smaller CO2 injection volume than in non-FD patients. These patients also had difficulties with belching.

DOI： 10.1371/journal.pone.0271456

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: There is no consensus on the relationship between saliva secretion and non-erosive reflux disease (NERD). In this study, saliva secretion and salivary epidermal growth factor (EGF) in patients with NERD were examined. METHODS: Thirty-one PPI-responsive NERD patients and 31 control subjects were recruited for this case-control study. Saliva secretion testing was performed. Saliva secretion was assessed as follows: each patient chewed sugar-free gum for 3 min prior to endoscopy, and the amount and pH of saliva before and after acid loading as an index of the acid-buffering capacity were measured. The salivary EGF concentration was assessed by ELISA. RESULTS: The amount of saliva secreted was significantly lower in the NERD group than in the control group, with medians (25th-75th percentile) of 4.0 mL/3 min (2.0-6.0) and 6.0 (3.9-8.0), respectively (p = 0.0131). Salivary pH was significantly lower in the NERD group (7.0 [6.8-7.2]) than in the control group (7.2 [7.0-7.3], p = 0.0100). Salivary pH after acid loading was significantly lower in the NERD group (5.8 [5.4-6.2]) than in the control group (6.3 [6.1-6.5], p = 0.0002). The difference in pH of stimulated saliva after acid loading (1.2 [0.9-1.5], p = 0.0021) was significantly higher in the NERD group than in the control group (0.8 [0.7-1.1]). The salivary EGF concentration was significantly higher in the NERD group (2513.0 pg/mL [1497.5-5005.0] than in the PPI-responsive group (1641.0 [1139.8-2092.0], p = 0.0032). CONCLUSION: Stimulated saliva secretion was reduced in PPI-responsive NERD patients.

DOI： 10.1007/s10388-021-00845-x

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Salivary secretion in patients with mild reflux esophagitis has not been examined. In this study, saliva secretion and salivary epidermal growth factor (EGF) in patients with mild reflux esophagitis were investigated. METHODS: Thirty-eight mild reflux esophagitis patients and 38 control subjects were recruited for this case-control study. Saliva secretion testing was performed. Saliva secretion was assessed as follows: each patient chewed sugar-free gum for 3 min prior to endoscopy, and the volume and pH of saliva before and after acid loading as an index of the acid-buffering capacity were measured. The salivary EGF concentration was assessed by ELISA. RESULTS: The volume of saliva secreted was significantly (p = 0.0412) lower in the mild reflux esophagitis group than in the control group, with medians (25th-75th percentile) of 4.2 mL/3 min [2.6-6.2] and 6.0 [3.9-8.0], respectively. No significant differences were observed in salivary pH (the mild reflux esophagitis group: 7.1 [6.9-7.2], the control group 7.2 [7.1-7.3]). Salivary pH after acid loading was significantly (p = 0.0009) lower in the mild reflux esophagitis group (5.9 [5.5-6.3]) than in the control group (6.3 [6.2-6.5]). No significant differences were noted in salivary EGF concentrations (the mild reflux esophagitis group: 1739.0 pg/mL [1142.3-3329.0], the control group: 1678.0 [1091.8-2122.5]. CONCLUSION: The secretion volume and acid-buffering capacity of stimulated saliva were reduced in patients with mild reflux esophagitis.

DOI： 10.1007/s10388-021-00880-8

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A new automated diagnostic program for high-resolution esophageal manometry (HREM) has been developed. This diagnostic program could detect locations of landmarks and could make final diagnoses automatically. However, the accuracy of the program is not known. The aim of this study was to evaluate the accuracy of the automated diagnostic program for HREM. METHODS: A total of 445 studies were enrolled. An HREM system (Starlet®) was used, and esophageal motility was diagnosed using the Chicago classification v3.0. First, the locations of the upper esophageal sphincter, transition zone, lower esophageal sphincter, esophago-gastric junction, crural diaphragm and stomach were determined, and each swallow was checked manually. Then, the parameters of the Chicago classification were calculated using an analytic program of the Starlet, and diagnoses were made by three experts. Second, all study raw data were analyzed again by the automated diagnostic program. Diagnoses made by the program were compared to those made by experts to evaluate the accuracy of the diagnoses. RESULTS: The new diagnostic program could identify the landmarks of each swallow, calculate the parameters and make a final diagnosis within 10 s. The diagnoses made by the automated diagnostic program were not matched to those made by experts in only 10 studies, and the overall accuracy of the new automated diagnostic program thus reached 97.8% (435/445). CONCLUSIONS: The new automated diagnostic program for HREM is clinically useful in terms of high diagnostic accuracy and time-saving.

DOI： 10.1007/s00535-021-01794-z

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Salivary secretion in patients with proton-pump inhibitor (PPI)-resistant severe reflux esophagitis has not been examined. In this study, saliva secretion and salivary epidermal growth factor (EGF) in patients with PPI-resistant severe reflux esophagitis were investigated. METHODS: We recruited 22 PPI-resistant and 22 PPI-responsive severe reflux esophagitis patients who were not infected with Helicobacter pylori. Saliva secretion testing and esophageal manometry using high-resolution manometry were performed. Saliva secretion was assessed as follows: each patient chewed sugar-free gum for 3 min prior to endoscopy and the amount and pH of saliva as well as the pH of saliva after acid loading as an index of the acid-buffering capacity were measured. The salivary EGF concentration was assessed by ELISA. RESULTS: The amount of saliva secreted was significantly lower in the PPI-resistant group than in the PPI-responsive group, with medians (25th-75th percentile) of 3.7 (2.2-6.8) and 4.9 (4.0-7.8) mL, respectively (p = 0.029). Salivary pH was significantly lower in the PPI-resistant group [6.9 (6.7-7.2)] than in the PPI-responsive group [7.2 (7.1-7.4), p = 0.001]. Salivary pH after acid loading was significantly lower in the PPI-resistant group [5.6 (5.3-5.9)] than in the PPI-responsive group [6.4 (6.1-6.5), p = 0.002]. The salivary EGF concentration was significantly higher in the PPI-resistant group [3211.5 (1865.0-4121.5)] than in the PPI-responsive group [1816.0 (1123.5-2792.3), p = 0.041]. No significant differences were observed in the proportion of esophageal motility abnormalities. CONCLUSION: Stimulated saliva secretion was reduced in PPI-resistant severe reflux esophagitis patients.

DOI： 10.1007/s10388-021-00825-1

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE PUBLICATIONS LTD  

Proton pump inhibitor-refractory reflux esophagitis is one of the intractable conditions of systemic sclerosis for which new treatments are required. Vonoprazan is a novel potassium-competitive acid blocker and has been shown to have several advantages over conventional proton pump inhibitors, including a long duration of gastric acid suppression. To investigate the efficacy of vonoprazan for treating proton pump inhibitor-refractory reflux esophagitis in patients with systemic sclerosis, 10 patients with proton pump inhibitor-refractory reflux esophagitis who were switched to vonoprazan were selected from our systemic sclerosis database. Reflux esophagitis was evaluated by endoscopy, and gastroesophageal reflux disease-related symptoms were assessed by the frequency scale for the symptoms of gastroesophageal reflux disease questionnaire before and after switching from proton pump inhibitor to vonoprazan at an average interval of 3.5 [2-5.5] months. After switching patients to vonoprazan, the endoscopic findings of reflux esophagitis were significantly improved (p = .033), and six patients (60%) achieved mucosal healing. The total frequency scale for the symptoms of gastroesophageal reflux disease score was also significantly decreased (p = .043), mainly by improving the acid reflux score. Vonoprazan was well tolerated and was continued for 15.5 [11.25-23.75] months in all patients. Vonoprazan is a potential treatment option for treating proton pump inhibitor-refractory reflux esophagitis in systemic sclerosis patients.

DOI： 10.1177/23971983211021747

Web of Science

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Aim: Although one of the causes of dyspeptic symptoms in functional dyspepsia patients is gastric hypersensitivity, there is currently no routine endoscopic gastric hypersensitivity test. We developed a new endoscopic method for gastric hypersensitivity testing. The aim of the present study was to investigate whether this method is useful for evaluating gastric hypersensitivity in drug-resistant functional dyspepsia patients who were strongly suspected of having gastric hypersensitivity. Methods: Twenty-seven drug-resistant functional dyspepsia patients and 27 nonfunctional dyspepsia patients were recruited. Gastric pressure was assessed using an external pressure transducer, and the CO2 insufflation volume was measured using an endoscopic CO2-supplied device and flow meter. The following variables were examined: gastric pressure at baseline and gastric pressure, the CO2 insufflation volume, and compliance of the stomach when patients initially felt abdominal tension following CO2 insufflation. Results: No significant differences were observed in baseline gastric pressure or compliance of the stomach between the groups. Drug-resistant functional dyspepsia patients had a significantly smaller CO2 insufflation volume and lower gastric pressure when symptoms developed than nonfunctional dyspepsia patients. Based on a cutoff value of 1.25 L by receiver operating characteristic curves, sensitivity and specificity for gastric pressure were 85.0 and 96.3%, respectively. Similarly, based on a cutoff value of 12.7 mmHg, sensitivity and specificity for the CO2 insufflation volume were 81.5 and 81.5%, respectively. Conclusion: This endoscopic gastric hypersensitivity testing is a useful tool for evaluating the presence of gastric hypersensitivity.

DOI： 10.1002/jgh3.12544

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The reliability of methods to identify the circumferential position of small lower esophageal lesions remains unknown. We prospectively investigated a new method for distinctively presenting lesion positions as times on a clock face. METHODS: Eighty-seven patients were consecutively examined by endoscopy. After observing the esophagus, an endoscope was inserted into the stomach and fixed, setting the greater curvature folds at the upper gastric corpus horizontal on the endoscope monitor display. The scope was retrogressed into the lower esophagus. At this point, the right wall at the hiatus may be at the 3 o' clock position (R-line). The scope was then retrogressed from the gastric angle to the cardia along the center of the lesser curvature in the retroflexed view to obtain the LC-line (the center of the lesser curvature at the cardia). The LC-line in the esophageal hiatus in the frontal view was then identified. The angle between the R- and LC-lines (R-LC) was measured. RESULTS: Seventy-seven patients were examined after excluding 7 with >2-cm hernias and 3 with esophageal stenosis. R-LC angles ranged between -38° and +35°. The mean R-LC angle was -0.3° ± 15.9° and its 95% confidence interval was [-4.0°, 3.3°] within [-15°, + 15°]. When indicating lesion locations as times on a clock face, there may be an error of ±30 min (±15°); therefore, R- and LC-lines were demonstrated to be identical using an equivalence test. CONCLUSIONS: Using this method, the circumferential position of small lower esophageal lesions may be reliably represented as a clock face.

DOI： 10.1272/jnms.JNMS.2021_88-102

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

BACKGROUND: Although the efficacy of rikkunshito in patients with treatment-resistant non-erosive gastroesophageal reflux disease (NERD) has been reported, it is unclear for which subgroups of NERD patients (per the Rome IV criteria) rikkunshito is effective. The objective of this study was to investigate the efficacy of rikkunshito in patients with functional heartburn. METHODS: Ten patients with functional heartburn who experienced symptoms of dyspepsia were enrolled. The patients were administered rikkunshito for 8 weeks. The frequency scale for the symptoms of GERD (FSSG), Japanese translation of quality of life in reflux and dyspepsia questionnaire (QOLRAD-J), and hospital anxiety and depression scale (HADS) were evaluated before and 4 and 8 weeks after administration. Overall treatment efficacy (OTE) was evaluated 8 weeks after administration. RESULTS: One patient was discontinued 4 weeks after administration because of voluntary withdrawal. Total FSSG score was significantly (P = 0.039) lower 8 weeks after treatment or at discontinuation (13.2 ± 8.0) than before treatment (18.3 ± 10.7). Although QOLRAD-J score tended to increase 8 weeks after treatment or at discontinuation compared with before treatment, no significant difference was observed. HADS score did not decrease significantly 8 weeks after treatment or at discontinuation compared with before treatment. However, a correlation was found between total FSSG and HADS anxiety scores (correlation coefficient: 0.684, P = 0.027). CONCLUSIONS: This was the first study to investigate the efficacy of rikkunshito in patients with functional heartburn. Rikkunshito may be effective in these patients.

DOI： 10.1272/jnms.JNMS.2022_89-106

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIMS: Functional dyspepsia (FD) is often comorbid with sleep disturbance. However, it is not fully understood how sleep disturbance affects the pathophysiology of FD. We aimed to investigate the relationship between FD and sleep disturbance. METHODS: We prospectively enrolled 20 FD patients with sleep disturbance between December 2018 and July 2019. Patients took sleep aids for 4 weeks and filled out questionnaires before and after taking sleep aids. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Athens Insomnia Scale (AIS) were used to evaluate the severity of their sleep disturbance. Modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (mFSSG), Gastrointestinal Symptom Rating Scale (GSRS), and the Japanese version of Patient Assessment of Constipation Quality of Life (JPAC-QOL) were used to evaluate the severity of GI symptoms. Short-Form 36-Item Health Survey (SF-36) was used to evaluate QOL. Pre- and post-sleep medication values of questionnaires were compared. RESULTS: Among 20 enrolled patients, 16 completed the study protocol. Zolpidem, eszopiclone, and suvorexant were administered to six, nine, and one patient, respectively. Each median total score of questionnaires (pre-/post-sleep medication, respectively) was as follows: PSQI, 10.0/8.5; ESS, 12.5/5.0; AIS, 10.0/4.0; mFSSG, 21.0/16.0; GSRS, 44.0/31.0 (Pain in GSRS, 11.0/5.0); JPAC-QOL, 26.0/15.5; SF-36, 63.9/71.9. All of these results showed statistically significant differences between pre- and post-sleep medication (p < 0.05). CONCLUSIONS: Improvement of sleep disturbance by administration of sleep aids resulted in improvement of GI symptoms and QOL in patients with FD. This effect may be related to pain modification.

DOI： 10.1186/s12876-021-01659-y

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Behavioral disorders, such as supragastric belching (SGB) and rumination syndrome (RS), which may be treated by cognitive behavioral therapy, are common in patients with reflux symptoms refractory to proton pump inhibitors (PPI). Vonoprazan (VPZ) has been used as a new type of acid inhibitor in Japan since 2015. We herein investigated the prevalence of behavioral disorders in patients with VPZ-refractory reflux symptoms and attempted to identify predictive factors. METHODS: We retrospectively analyzed esophagogastroduodenograms, high-resolution manometry, and 24-h multiluminal impedance pH-metry (MIIpH) in patients with VPZ-refractory reflux symptoms (heartburn or regurgitation) receiving 20 mg VPZ who underwent these tests at our hospital between January 2015 and April 2020. Patients were divided as follows: non-erosive reflux disease with pathological esophageal acid exposure (NERD), functional heartburn (FH), reflux hypersensitivity (RH), excessive (> 13 per day) SGB, and possible RS based on MIIpH parameters. RESULTS: Among 49 patients, 6 (12.2%) had SGB, 4 (8.2%) possible RS, 29 (59.2%) FH, 9 (18.4%) RH, and 1 (2%) NERD. Possible RS patients had more postprandial non-acid reflux events than FH patients (p < 0.05). The multivariate logistic regression analysis did not identify any predictive factors with statistical significance. CONCLUSION: More than 20% patients with VPZ-refractory reflux symptoms had behavioral disorders. The use of HRM and MIIpH may be clinically relevant for a better diagnosis and more specific treatment.

DOI： 10.1007/s00535-020-01751-2

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The relationship between gastroesophageal reflux disease (GERD) and constipation has not yet been examined in Japan. We herein analyzed the use of laxatives by GERD and non-GERD patients to clarify the relationship between GERD and constipation. METHODS: This was a retrospective observational study designed to examine the use of laxatives by GERD and non-GERD patients. A total of 118 patients (mean age 69.7 years, 50 males) with reflux esophagitis (RE) and non-erosive reflux disease (NERD) who received maintenance acid-suppressive therapy for more than 1 year were included in the GERD group (83 RE patients, 35NERD patients). Similarly, 61 patients (mean age 69.4 years, 28 males) who received regular acid-suppressive therapy for reasons other than GERD were included in the non-GERD group. We also investigated demographic factors associated with the onset of GERD, including body mass index (BMI), age, and sex. RESULTS: The frequency of laxative use was significantly higher in the GERD group (38.1%) than in the non-GERD group (21.3%). No significant differences were observed in dose frequencies between the groups. The type of laxative used also did not significantly differ between the groups. Furthermore, no significant differences were noted in sex, age, or BMI between the groups. CONCLUSIONS: The use of laxatives was significantly more common in GERD patients than in non-GERD patients. The present results suggest that a relationship exists between GERD and constipation.

DOI： 10.1007/s10388-020-00770-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Jackhammer esophagus (JE) is a rare disease with unclear clinical features. The objective of this study was to retrospectively compare the clinical characteristics of patients with JE whose symptoms were controlled with conservative treatment, such as observation or medication, versus those who were required surgical treatment, such as surgical myotomy or per oral endoscopic myotomy. METHODS: Eighteen patients with JE were included in this study. The patients were divided into two groups: patients who responded to conservative treatment (C group) and patients who were refractory to conservative treatment and underwent surgery (S group). Patient age, sex, disease duration before treatment, symptoms, esophagogastroduodenoscopic (EGD) findings, esophagographic findings, esophageal wall thickness on computed tomography, number of swallows with hypercontractile peristalsis in 10 water swallows, and maximum distal contractile integral (DCI) were compared between the groups. RESULTS: Thirteen of 18 patients (72%) were in the C group and five of 18 (28%) were in the S group. There were no significant differences in age, sex, disease duration before treatment, symptoms, EGD findings, esophagographic findings, esophageal wall thickness, or number of swallows with hypercontractile peristalsis between the groups. On Starlet high-resolution manometry, the median maximum DCI value was significantly higher in the S group (32,651 mmHg-s-cm) than in the C group (17,926 mmHg-s-cm) (P = 0.0136). CONCLUSIONS: JE treatment should be carefully considered because some patients require surgery, whereas others are controlled with conservative treatment alone. A higher DCI value in patients with JE may predict resistance to conservative treatment.

DOI： 10.1007/s10388-020-00748-3

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

本邦では内視鏡検査は広く行われ，器質的疾患の診断に大きく貢献している．一方，機能性疾患に関しては，内視鏡検査の役割は器質的疾患の除外にとどまっているのが現状である．近年，食道運動異常症の代表的疾患であるアカラシアに関しては，新たな内視鏡所見（"Esophageal Rosette"，"Gingko-Leaf sign"，"Champagne Glass sign"，"Pinstripe Pattern"）が報告され，内視鏡検査によりアカラシアを強く疑うことが可能になってきている．食道体部運動異常を有する疾患に関しても，嚥下障害を認め，内視鏡検査においてらせん状収縮波，多発同期性収縮波，食道の狭小化（伸展不良）を認める場合には，食道運動異常症を有する可能性がある．内視鏡的に体部運動異常を見るためには食道中部でのスコープを固定し食道を観察することが重要である．アカラシア診断のgold standardはHigh-Resolution Manometry（HRM）であるが，HRMによる診断も絶対的なものではない．嚥下障害を有する患者に対しては，常に食道運動異常症を念頭に置き，内視鏡，食道造影，HRMによる総合的な評価をし，診断することが重要である．

DOI： 10.11280/gee.63.2308

CiNii Research

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

目的:当院では食道運動機能障害に対して2018年10月よりPOEMを開始した。今回、その短期成績を検討した。方法:2019年12月までに施行したPOEM16症例を対象とし、対象疾患、施行時間、筋層切開長、術後入院日数、合併症、POEM前後の食道内圧検査所見及び治療効果について後方視的に解析した。結果:原疾患は食道アカラシア(EA)12例、jackhammer esophagus(JE)3例、esophagogastric junction outlet obstruction(EGJOO)1例であった。施行時間は91.0(65-196)分、筋層切開長は8.0(5-21)cmであり、術後の入院日数は3.0(2-5)日間であった。重篤な有害事象は認めなかった。Eckardt scoreは中央値5.5→1.5と有意に改善し(p値=0.005)、F scaleも中央値21.0→11.0と改善を認めた(p値=0.004)、術後2ヵ月に食道内圧検査を施行した13例中、EA9例とEGJOO1例でIRPが中央値29.6→10.1mmHgに低下(p値<0.005)、JE3例ではDCIが中央値8831.4→849.2mmHg/s/cmと低下した。結語:当院においてもPOEMを安全に導入し、良好な成績を示すことができた。今後さらなる症例の蓄積と長期成績についての検討が必要である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J04450&link_issn=&doc_id=20201225120001&doc_link_id=130007966568&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007966568&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Proton pump inhibitor (PPI) therapy causes hypergastrinemia, which could promote the development and progression of neuroendocrine tumors (NETs). Concerns have been raised about the safety of long-term PPI use due to a possible increased risk of NETs. This study aimed to investigate the association between hypergastrinemia and the risk of NETs. Twenty outpatients presenting with serum gastrin levels greater than 400 pg/mL after long-term PPI treatment were registered in this study. Immunohistochemical analyses for chromogranin A (CgA), Ki67, gastrin and CCK/B gastrin receptor (CCKBR) were performed, and positive cell numbers were counted. There were no NET or gastric epithelial neoplasia cases observed among any of the 20 patients examined throughout the PPI treatment period. Histologically, ECL cell hyperplasia were shown in all patients. However, no relationship was found between serum gastrin levels and the number of CgA positive ECL cells. There was also no relationship between serum gastrin levels and the proportion of Ki67 positive cells or the density of CCKBR positive cells. The data indicate no relationship may exist between NETs and hypergastrinemia secondary to PPI treatment in patients having no, or mild, atrophic gastritis.

DOI： 10.1016/j.prp.2020.153113

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The diagnosis of achalasia can occasionally be difficult because of the low prevalence of apparent endoscopic abnormal findings, such as dilation and food residue, and lack of "esophageal rosette" in some patients. We have found a new endoscopic finding "Gingko leaf sign", which consists of not being able to see the full extent of the esophageal palisade vessels and a Gingko leaf-shaped morphology of a longitudinal section of the esophagogastric junction at the end of a deep inspiration, in some achalasia patients without "esophageal rosette". The aim of the study was to investigate the prevalence of "Gingko leaf sign" in these patients. METHODS: We retrospectively compared the prevalence of "Gingko leaf sign" between 11 achalasia patients without "esophageal rosette" and 22 age-/gender-matched healthy subjects. The diagnoses of achalasia were based on the results of high-resolution manometry. We also investigated the characteristics of the patients with "Gingko leaf sign". RESULTS: All the patients had "Gingko leaf sign", in contrast to none of the healthy subjects (p < 0.001). Four of 11 patients did not require any therapy. Six of seven patients did not relapse after balloon dilatation, but one patient required per-oral endoscopic myotomy 8 months after balloon dilatation. CONCLUSION: All our achalasia patients without "esophageal rosette" had "Gingko leaf sign". It is possibly a useful endoscopic finding in achalasia patients without "esophageal rosette".

DOI： 10.1007/s10388-019-00684-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In a previous study that used the Starlet high-resolution manometry system to assess integrated relaxation pressure (IRP) in healthy adults, the predicted cutoff value was about 26 mm Hg. However, some patients with achalasia have an IRP value of <26 mm Hg. This study examined the validity of the Starlet IRP cutoff value in patients with achalasia. METHODS: Among 37 patients with achalasia, the percentage of patients with a Starlet IRP value ≥26 mm Hg was calculated. Patients were then classified as IRP-high (IRP ≥26 mm Hg) and IRP-low (IRP <26 mm Hg), and the groups were compared in relation to basal lower esophageal sphincter (LES) pressure, Chicago classification achalasia subtype, and esophagography subtype. RESULTS: Twenty (54%) of the 37 patients had an IRP of ≥26 mm Hg. Basal LES pressure was significantly higher in the IRP-high group than in the IRP-low group. Chicago classification Type II achalasia was most common in the IRP-high group, whereas Type I was most common in the IRP-low group. No significant difference was noted in the distribution of esophagography subtypes between groups. CONCLUSIONS: It is difficult to determine an IRP cutoff value with Starlet. When diagnosing achalasia with Starlet, comprehensive assessment must consider findings other than IRP values. In addition, IRP was associated with Chicago classification type.

DOI： 10.1272/jnms.JNMS.2019_86-608

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To examine the clinical characteristics, including complications, of patients older than 75 years of age with proton pump inhibitor-resistant reflux esophagitis. METHODS: Patients who were resistant to standard-dose proton pump inhibitors were enrolled in the present study. Eligible patients (n = 26) were divided into those who were older (n = 11) and younger (n = 15) than 75 years of age. Clinical characteristics including complications (hemorrhage and stricture), body mass index, the severity of reflux esophagitis, Helicobactor pylori infection, gastric mucosal atrophy, hiatal hernia, kyphosis, and the use of antithrombotic agents were examined. The efficacy of 20 mg vonoprazan for proton pump inhibitor-resistant reflux esophagitis was also investigated. RESULTS: The severity of reflux esophagitis was significantly higher in the elderly group than in the non-elderly group. No other significant differences were observed between the groups. The proportion of patients with hemorrhage was significantly larger in the elderly group than in the non-elderly group. Similarly, the proportion of patients with stricture was significantly larger in the elderly group than in the non-elderly group. Nine out of 10 patients in the elderly group and all patients in the non-elderly group achieved healing after the 4-week administration of 20 mg vonoprazan. No significant differences were observed in healing rates between the groups. CONCLUSION: Among patients with proton pump inhibitor-resistant reflux esophagitis, the rates of severe reflux esophagitis and complications (hemorrhage and/or stricture) were significantly higher in elderly patients than in non-elderly patients. Regardless of age, 20 mg vonoprazan was effective for proton pump inhibitor-resistant reflux esophagitis.

DOI： 10.1007/s10388-019-00702-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The values of the parameters in the Chicago classification measured by a high-resolution manometry (HRM) system with the Unisensor catheter (Starlet) are significantly different from those measured by the ManoScan. The contraction vigor is categorized by values of the distal contractile integral (DCI) in the Chicago classification v3.0; however, reference values of the DCI in the Starlet and the clinical impact of the different reference values in the Starlet and ManoScan on diagnosing esophageal motility disorders are not known. METHODS: We evaluated data from a previous report in which ManoScan and Starlet were compared in the same subjects. The DCI values in each system were compared and reference DCI values were calculated. Moreover, diagnoses assessed by Starlet using reference values in ManoScan were compared with those using calculated reference values and those assessed by ManoScan. RESULTS: There was a significant positive correlation between the DCI values measured by ManoScan and those measured by Starlet (r = 0.80, p < 0.01). Based on a linear functional relationship considering measurement errors, the reference DCI values for diagnosing failed, weak and hypercontractile contraction vigor were calculated as 590.6, 1011.3 and 10,085.8 mmHg-s-cm, respectively, in the Starlet. Therefore, the proposed reference values in the Starlet were 500, 1000 and 10,000 mmHg-s-cm, respectively. When the reference values in the ManoScan were used in the Starlet data, approximately 30% of subjects were diagnosed inappropriately. This issue was resolved using the proposed reference values in the Starlet. CONCLUSION: Recognizing systemic differences in HRM systems is important.

DOI： 10.1007/s00535-019-01608-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To investigate the efficacy of long-term (52 weeks) maintenance therapy by 10-mg vonoprazan administration for proton pump inhibitor-resistant reflux esophagitis continued from the preceding study. METHODS: Sixteen patients with proton pump inhibitor-resistant reflux esophagitis (mean age 70.9 years, eight males) in whom endoscopic healing was achieved by 20-mg vonoprazan administration for 4 weeks and maintenance of remission was maintained by 10-mg vonoprazan administration for 8 weeks were enrolled. Endoscopy was performed at 52 weeks after the initiation of maintenance therapy with 10-mg vonoprazan to evaluate whether there was any recurrence of reflux esophagitis. Changes in the gastric mucosa were investigated at 52 weeks. Symptoms were assessed using the frequency scale for the symptoms of gastroesophageal reflux disease and the fast gastrin level at 8 and 52 weeks following the maintenance therapy. RESULTS: Endoscopic remission was maintained at 52 weeks in 15 (93.8%) of the 16 patients with proton pump inhibitor-resistant reflux esophagitis. One patient relapsed with grade C of reflux esophagitis. There were no significant differences in the symptom score at 8 and 52 weeks, nor the gastrin level at 8 and 52 weeks. There was no change in the stomach on endoscopy at 52 weeks. CONCLUSION: Long-term maintenance therapy by 10-mg vonoprazan administration is very effective for proton pump inhibitor-resistant reflux esophagitis patients in whom endoscopic healing was maintained by 8 weeks maintenance therapy with 10-mg vonoprazan administration.

DOI： 10.1007/s10388-019-00676-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To evaluate the efficacy of on-demand therapy using 20-mg vonoprazan for non-erosive reflux disease. METHODS: On-demand therapy by taking one 20-mg tablet of vonoprazan only when reflux symptoms occurred was performed for 8 weeks by 30 patients (11 men, mean age: 67.8) with non-erosive reflux disease who responded well to maintenance therapy using proton pump inhibitor and answered "very satisfied" or "satisfied" to an overall satisfaction survey (5-grade scale). The degree of overall satisfaction with the treatment, score of symptoms, and fasting gastrin levels before breakfast was examined before and after on-demand therapy. The number of vonoprazan tablets taken and the frequency (regular, temporary, rare) of its administration were also investigated. RESULTS: All patients completed 8-week on-demand therapy with 20-mg vonoprazan. Comparisons of patient satisfaction levels before and after therapy revealed no significant differences in the number of patients who were very satisfied and satisfied with the therapy. Furthermore, there were no significant differences in score of symptoms or gastrin levels before and after therapy. During 8-week on-demand therapy, patients took 11 tablets (median) (7.0-18.0 tablets: 25-75 percentiles), and 30.0% of patients (n = 9) took vonoprazan on a regular basis (at least 2 tablets a week). CONCLUSION: On-demand therapy with 20-mg vonoprazan exerted equivalent effects to continuous PPI maintenance therapy for patients with non-erosive reflux disease.

DOI： 10.1007/s10388-018-00654-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Tokyo  

Background: To investigate the relationship between endoscopic and esophageal manometric hiatus hernia (HH). Methods: Forty-six gastroesophageal reflux disease patients with endoscopic HH under maintenance therapy were recruited. Endoscopy was performed on all patients in a fully conscious state. Endoscopic HH was defined as apparent separation greater than 1 cm of the lower margin of the esophageal palisade vessels and the diaphragm hiatus on endoscopy under deep inspiration. Esophageal manometry was conducted using high-resolution manometry (HRM). The length between the lower margin of the lower esophageal sphincter and pulmonary inversion point was measured 10 times. The mean and maximum of the length was then calculated. Results: The mean HH length on HRM was 0 cm (0–0) [median (25th to 75th percentile)], 0 cm (0-0), 0.5 cm (0–1.1), and 2.2 cm (1.3–2.5) in the groups with endoscopic HH lengths of 1–2, 2–3, 3–4, and 4–5 cm, respectively. The maximum HH length on HRM was 0 cm (0–0), 0 cm (0–0), 0.8 cm (0–1.4), and 2.4 cm (1.5–2.9) in the 1–2, 2–3, 3–4, and 4–5 cm endoscopic HH groups, respectively. The mean and maximum HH lengths increased significantly in the group with an endoscopic HH length of 4–5 cm compared with the other groups, but did not differ significantly among the 1–2, 2–3, and 3–4 cm groups. Of patients with endoscopic HH less than 3 cm, few had esophageal manometric HH greater than 2 cm. Conclusions: Endoscopic diagnosis of HH under deep inspiration is not consistent with esophageal manometric diagnosis, leading to overdiagnosis.

DOI： 10.1007/s00535-017-1403-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The present study examined the pathogenesis of potassium-competitive acid blocker (P-CAB)-resistant non-erosive reflux disease (NERD). METHODS: Forty-three patients with NERD, who had persistent reflux symptoms despite the administration of P-CAB, were included in this study. After excluding eosinophilic esophagitis and primary esophageal motility disorders, esophageal impedance-pH monitoring was performed. In symptom index (SI)-positive patients, the mechanism of SI-positivity and percent time with intragastric pH > 4 and with esophageal pH < 4 were investigated according to the presence or absence of Helicobacter pylori infection. RESULTS: One (2.3%) of 43 patients had a primary esophageal motility disorder (Jackhammer esophagus). Eighteen (41.9%) and 3 (7%) patients were SI-positive for liquid and gas-only reflux, respectively, and the remaining 21 patients who were SI-negative (48.8%) had functional heartburn. All patients SI-positive for liquid reflux were SI-positive for weakly acidic reflux. Gastric acid was sufficiently suppressed by P-CAB, regardless of the presence or absence of H. pylori infection. CONCLUSIONS: The pathogenesis of -P-CAB-resistant NERD was elucidated in 51% of patients. Symptoms in all patients SI-positive for liquid reflux were related to weakly acidic reflux, and symptoms related to acid reflux may be ruled out by the administration of P-CAB.

DOI： 10.1159/000488530

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：S. Karger AG  

Background: The study aimed to evaluate the efficacy of on-demand therapy using 20-mg vonoprazan for mild reflux esophagitis (RE). Methods: On-demand therapy by taking one 20-mg tablet of vonoprazan only when reflux symptoms occurred was performed for 24 weeks using 30 patients with mild RE who were receiving maintenance therapy with proton pomp inhibitors (PPIs). The presence or absence of RE, degree of overall satisfaction with the treatment, score of symptoms, and fasting gastrin level before breakfast were examined before and after on-demand therapy. The number of tablets taken during the 24-week period was also noted. Results: One of the 30 patients dropped out of on-demand therapy 1 week after its initiation. Remission was maintained in 25 (86.2%) of the 29 patients (all 10 [100%] Los Angeles classification grade A patients and 15 (78.9%) of the 19 grade B patients). However, 4 grade B patients exhibited grade B relapse. There were no differences in the degree of overall satisfaction, score of symptoms or the gastrin level between PPI and on-demand therapies. The number of vonoprazan tablets taken during the observation period was 33 tablets (median)/24 weeks. Conclusion: On-demand therapy using 20-mg vonoprazan tablets is an effective alternative maintenance therapy for mild RE.

DOI： 10.1159/000485795

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：英語   出版者・発行元：SPRINGER JAPAN KK  

DOI： 10.1007/s10388-017-0576-6

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記述言語：英語   出版者・発行元：SPRINGER JAPAN KK  

The cause of reflux esophagitis (RE) is excessive esophageal acid exposure. Acid reflux and acid clearance after acid reflux are important factors related to excessive esophageal acid exposure. The main mechanism responsible for acid reflux is transient lower esophageal sphincter relaxation (TLESR), which is LES relaxation not associated with swallowing, and acid reflux caused by low LES pressure is rare. The frequency of TLESR in the postprandial period does not significantly differ between healthy subjects and gastroesophageal reflux disease (GERD) patients; however, the proportion of acid reflux episodes during TLESR is significantly higher in GERD patients. The layer of acid that appears above the dietary layer immediately below the esophagogastric junction (acid pocket) is attracting increasing attention as a cause of the difference in the proportion of acid reflux episodes during TLESR. The proportion of acid reflux episodes during TLESR is significantly higher when the acid pocket is present in the hernia sac than when it is located below the diaphragm. The acid pocket also shows upward migration and reaches the esophageal side of the esophagogastric junction, and the acid pocket itself has been suggested to cause mucosal damage in the lower esophagus. The amplitude and success rate of primary peristalsis decreases with increases in the severity of RE, leading to excessive esophageal acid exposure. Furthermore, the success rate of secondary peristalsis is lower in GERD patients than in healthy subjects.

DOI： 10.1007/s10388-017-0575-7

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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

Acotiamide is a new drug that exhibits prokinetic activity by enhancing the release of acetylcholine. However, its effects on esophageal motility currently remain unknown. Therefore, we herein investigated the effects of acotiamide on esophageal motility in healthy, asymptomatic subjects.
Thirty healthy subjects received 100 mg of acotiamide or placebo three times a day for 7 days separated by a 28-day washout period in a randomized, double-blind, placebo-controlled crossover study. On the seventh day of treatment, esophagogastric junction pressure, integrated relaxation pressure, and primary peristalsis were assessed using high-resolution manometry.
Esophagogastric junction pressure was significantly higher in the acotiamide group (median 28.2 mmHg) than in the placebo group (24.0 mmHg), whereas no significant differences were observed in integrated relaxation pressure, the distal contractile integral, or contraction patterns between the two groups. Among 13 healthy subjects with peristaltic abnormalities, no significant differences were noted in integrated relaxation pressure or the distal contractile integral between the acotiamide and placebo groups; however, the esophagogastric junction pressure (acotiamide 23.4 mmHg; placebo 21.7 mmHg) significantly increased, the contraction pattern significantly improved, and the frequency of esophageal peristaltic abnormalities significantly decreased in the acotiamide group.
Acotiamide improves the peristaltic pattern in patients with peristaltic abnormalities by decreasing weak peristalsis with a small break.

DOI： 10.1007/s10388-016-0559-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Background: Laparoscopic anti-reflux surgery (LARS) is generally the treatment of choice for patients with gastroesophageal reflux disease (GERD). This report describes our experiences in performing LARS on patients with GERD, and focuses retrospectively on the pathophysiology of individual patients and the current status of Japanese patients who have undergone LARS. We demonstrate that patients with non-erosive reflux disease resistant to proton pump inhibitors (PPI-resistant NERD) and high-risk giant hernia, whom we are sometimes hesitant to treat surgically, can be safely and successfully treated with LARS (depending on the pathophysiology of individual patients).
Methods: Between January 2007 and June 2015, 37 patients underwent LARS at Nippon Medical School Hospital. These patients were retrospectively subgrouped according to pathophysiology; 9 of them had PPI-resistant NERD (Group A), 19 had a giant hiatal hernia (Group B), and 9 had erosive esophagitis (Group N). Patient characteristics, intraoperative bleeding, operation duration, perioperative complications, and length of hospital stay were determined, along with symptomatic outcomes and patient satisfaction.
Results: Patients in Group A were the youngest (average: 43.9 years), and those in Group B were the oldest (75.9 years) (P=0.002). The percentage of high-risk patients, as determined by performance status (P=0.047) and American Society of Anesthesiologists physical status classification (P=0.021), was highest in Group B, whereas the percentage of patients with mental disorders was highest in Group A (P=0.012). There were no significant differences among the groups in terms of intraoperative bleeding, surgery duration, or postoperative hospital stay. Thirty-three patients (89.2%), including all 19 in Group B, expressed excellent or good postoperative satisfaction levels.
Conclusions: The characteristics of the patients who underwent LARS at our hospital differed according to pathophysiology and from those in western countries. Satisfactory outcomes depended on the pathophysiology of individual patients.

DOI： 10.1272/jnms.84.25

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

裂孔ヘルニアが逆流性食道炎発症の原因である食道内の過剰な酸曝露に及ぼす影響については、必ずしも明確でない。近年、食後の胃内の食事層の上方に出現する酸の層が食後の酸逆流の供給源として注目されている。この酸の層はacid pocketと呼ばれる。Acid pocketが裂孔ヘルニア内に存在する場合には、酸逆流の主なメカニズムである一過性下部食道括約筋(LES)弛緩時に高頻度に酸逆流をともなう。裂孔ヘルニアと食道内酸排出に関しては、常時ヘルニア嚢を有する症例において、ヘルニア内と食道内圧の圧勾配により、ヘルニア内に酸が存在する場合には、嚥下にともない酸がヘルニア内と食道内の移動を繰り返す結果、食道酸排出時間が延長する。(著者抄録)

DOI： 10.11405/nisshoshi.114.1774

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J01118&link_issn=&doc_id=20171018100002&doc_link_id=1390001206403086080&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390001206403086080&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Background: Vonoprazan (VPZ) is a novel potassium-competitive acid blocker that may be clinically beneficial for proton pump inhibitor (PPI)-resistant reflux esophagitis (RE). The aim of this study was to investigate the efficacies of VPZ therapy at 20 mg for 4 weeks in patients with PPI-resistant RE and VPZ maintenance therapy at 10 mg for 8 weeks in patients who have been successfully treated. Methods: Subjects comprised 24 patients with PPI-resistant RE (Los Angeles classification grade A/B/C/D: 3/7/11/3). After confirming PPI-resistant RE by endoscopy, 20 mg VPZ was administered. Endoscopy was performed 4 weeks after the initiation of VPZ. Symptoms were evaluated using the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG). Maintenance therapy with 10 mg VPZ was performed and endoscopy was conducted after 8 weeks. Results: In 21 (87.5%) out of 24 patients, esophageal mucosal breaks were successfully treated by 20 mg VPZ. The median FSSG score was significantly lower on days 1-7, 14, and 28 after the initiation of VPZ than before its administration. Maintenance therapy with 10 mg VPZ prevented the relapse of esophageal mucosal breaks in 16 (76.2%) out of 21 patients. Conclusion: VPZ was effective for most patients with PPI-resistant RE. (C) 2017 S. Karger AG, Basel

DOI： 10.1159/000456072

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Background: Various mechanisms have been suggested to be responsible for contributing to the occurrence of proton pump inhibitor (PPI)-resistant non-erosive reflux disease (NERD). The aims of this study were to clarify the pathogenesis of PPI-resistant NERD. Methods: Fifty-three patients with NERD, who had persistent reflux symptoms despite taking double-dose PPI, were included in this study. After excluding eosinophilic esophagitis (EoE) and primary esophageal motility disorder, esophageal impedance-pH monitoring was carried out. In symptom index (SP-positive patients, the mechanism of SI positivity and the percent time with intragastric pH &gt;4 were investigated according to the presence or absence of Helicobacter pylori infection. Results: One of the 53 patients had EoE, and 4 had primary esophageal motility disorder. Twenty-three and 2 patients were SI-positive for liquid and gas-only reflux respectively. Of 17 SI-positive, H. pylori-negative patients, 5 were SI-positive for acid reflux, whereas all of the H. pylori-positive patients were SI-positive for non-acid reflux. The percent time with intragastric pH &gt;4 was significantly lower in the H. pylori-negative patients than in the H. pylori-positive patients. Conclusions: The pathogenesis of double-dose PPI-resistant NERD was identified in 57%. In some of H. pylon-negative patients, acid-related symptoms were observed. However, in H. pylori-positive patients,these symptoms were excluded bytaking double-dose PPI. (C) 2017 S. Karger AG, Basel

DOI： 10.1159/000455834

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KOREAN SOC NEUROGASTROENTEROLOGY & MOTILITY  

Background/Aims
Twenty-four-hour esophageal impedance and pH monitoring allows detection of all types of reflux episodes and is considered the best technique for identifying gastroesophageal refluxes. However, normative data for the Japanese population are lacking. This multicenter study aimed to establish the normal range, of 24-hour esophageal impedance and pH data both in the distal and the proximal esophagus in Japanese subjects.
Methods
Forty-two healthy volunteers (25 men and 17 women) with a mean +/- standard deviation age of 33.3 +/- 12.4 years (range: 22-72 years) underwent a combined 24-hour esophageal impedance and pH monitoring. According to the physical and pH properties, distal or proximal esophageal reflux events were categorized.
Results
Median 45 reflux events occurred in 24 hours, and the 95th percentile was 85 events. Unlike previous reports, liquid-containing reflux events are median 25/24 hours with the 95th percentile of 62/24 hours. Acidic reflux events were median 11/24 hours with the 95th percentile of 39/24 hours. Non-acidic gas reflux events were median 15/24 hours with the 95th percentile of 39/24 hours. Proximal reflux events accounted for 80% of the total reflux events and were mainly non-acidic gas refluxes. About 19% of liquid and mixed refluxes reached the proximal esophagus.
Conclusions
Unlike previous studies, liquid-containing and acidic reflux events may be less frequent in the Japanese population. Non-acidic gas reflux events may be frequent and a cause of frequent proximal reflux events. This study provides important normative data for 24 hour impedance and pH monitoring in both the distal and the proximal esophagus in the Japanese population.

DOI： 10.5056/jnm15195

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/MCG.0000000000000123

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000367650

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JOURNAL CLINICAL BIOCHEMISTRY & NUTRITION  

Comparisons between the acid inhibitory effects of rabeprazole and esomeprazole after single oral administration with standard doses have not been previously presented. We examined intragastric pH after oral administrations of these two proton pump inhibitors using 24-h pH monitoring. Fifty-four normal volunteers not infected by Helicobacter pylori were investigated. Using a cross-over design, we administered 10 mg of rabeprazole or 20 mg of esomeprazole in 27 at 30 min after supper and in the remaining 27 subjects at 15 min before supper, and performed 24-h pH monitoring. Intra-gastric pH data were nearly identical when the proton pump inhibitors were taken after meals. Even if the data were compared in different CYP2C19 genotypes, rabeprazole and esomeprazole did not show the difference. In poor metabolizer, both of the drugs showed stronger acid inhibition. When taken before meals, intra-gastric pH after esomeprazole administration was slightly but not significantly higher than that observed after rabeprazole administration not only in daytime but also in nighttime period. In conclusion, rabeprazole and esomeprazole were similarly effective when administered after a meal.

DOI： 10.3164/jcbn.14-41

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Background/Aims: The mechanisms that cause acid, reflux in patients with non-erosive reflux disease (NERD), including those that determine how acid extends proximally, are not yet clear. Methods: Concurrent esophageal manometry and pH monitoring were performed for 3 h after a meal in 13 patients with NERD, 12 with mild reflux esophagitis (RE), and 13 healthy subjects (HS). Results: Transient lower esophageal sphincter (LES) relaxation (TLESR) was the major mechanism of acid reflux in all three groups. LES pressure did not differ between the groups. At 2 cm above the LES, there were no differences between the three groups in the number of TLESR-related acid reflux episodes, rate of TLESRs and rate of acid reflux during TLESR. However, at 7 cm above the LES, the rate of acid reflux during TLESRs was significantly higher in patients with NERD (mean +/- SEM 42.3 +/- 4.8) than in those with mild RE (28.0 +/- 3.8) and HS (10.8 +/- 2.5). Conclusions: TLESRs are the sole motor events underlying acid reflux episodes in patients with NERD. Acid extends proximally more readily in patients with NERD than in HS and those with mild RE. (C) 2014 S. Karger AG, Basel

DOI： 10.1159/000365588

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記述言語：英語   出版者・発行元：The Japan Esophageal Society [編]  

We performed surgery for proton pump inhibitor-resistant non-erosive reflux disease patients whose symptom index, confirmed by combined multichannel intraluminal impedance-pH monitoring, was positive. Laparoscopic Nissen fundoplication was performed in five patients and laparoscopic Toupet fundoplication in 3 patients. In 6 of 8 patients, non-acid or minor acid reflux caused the symptoms. Satisfaction percentages assessed 1 year postoperatively were 12.5 % (excellent) and 87.5 % (good).The number of total reflux events decreased to 28.5 ± 14.4 % postoperatively. The symptom index decreased from 63.8 to 20.8 %. It is controversial whether the surgery reduces weakly acidic reflux to the same degree as acid reflux. Previous reports discuss the effect of laparoscopic Nissen fundoplication on acid and weakly acidic reflux; however, the results of these studies are contradictory. In our cases, laparoscopic Toupet fundoplication as well as Nissen fundoplication improved symptoms, and reduced acid and non-acid reflux similarly. These findings strongly support the importance of surgical intervention in proton pump inhibitor-resistant non-erosive reflux disease patients. © 2013 The Japan Esophageal Society and Springer Japan.

DOI： 10.1007/s10388-013-0360-1

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

胃食道逆流症と睡眠障害の関連性が注目されている。夜間胃酸逆流の主な発生機序は日中と同様に一過性下部食道括約筋(LES)弛緩時に発生するが、夜間胃酸逆流発生後の胃酸排出機序は日中とは異なり、二次蠕動波が重要である。しかし、非びらん性胃食道逆流症患者や逆流性食道炎患者では二次蠕動波の出現率は健常者に比べ低下しており、夜間胃酸逆流が発生すると胃酸が長時間食道内に停滞すると同時に、逆流症状をおこしやすい上部食道に胃酸が達するため、逆流症状が出現し睡眠障害をおこす可能性がある。また一過性LES弛緩発生時の睡眠状態は覚醒時または浅い睡眠状態であり、睡眠障害自体が夜間逆流を誘発している可能性もある。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J01118&link_issn=&doc_id=20130613240003&doc_link_id=1390282681378469248&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390282681378469248&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japan Society of Smooth Muscle Research  

Background: A study in Japan has found that nizatidine (NIZ) is more effective than other histamine H2 receptor agonists (H2RAs) in treating reflux esophagitis (RE), although the NIZ group included a greater number of patients with severe RE. As there was no difference in the level of acid suppression among H2RAs, it is possible that NIZ has other effects on esophageal acid exposure (EAE) besides acid suppression. In this study, the effect of NIZ on transient lower esophageal sphincter relaxations (TLESRs) and acid reflux was evaluated in healthy subjects. Methods: In 10 healthy subjects, while in a sitting position, esophageal motility and a pH study were measured for 3 hours after a meal on 2 separate days at least 2 weeks apart. Participants received an oral dose of 150 mg of NIZ, 60 min before the meal on one day and a placebo on the other. Both studies were preceded by a week of treatment with either NIZ (150 mg, bid) or a placebo and the order of treatment was randomized. Results: Basal LES pressure in the NIZ group (14.1 mmHg, median) was significantly greater than that of the placebo group (8.5 mmHg). The rate of TLESRs in the NIZ group (22.0/3 h) for the postprandial 3-hour period was significantly less than that of the placebo group (16.5/3 h) and the rate of acid reflux during TLESRs (24.7%) and the EAE (0.2%) in the NIZ group for the postprandial 3-hour period was also significantly less than that of the placebo group (74.4% and 2.8%, respectively). Conclusion: NIZ significantly reduces acid reflux by inhibiting both the rate of TLESRs and acid reflux during TLESRs.<br>

DOI： 10.1540/jsmr.47.157

PubMed

CiNii Books

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s12328-010-0172-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00535-009-0179-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00535-009-0173-0

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その他リンク： http://link.springer.com/article/10.1007/s00535-009-0173-0/fulltext.html

記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

近年プロトンポンプ阻害薬(PPI)抵抗性非びらん性胃食道逆流症(NERD)の原因の1つとして、胃酸以外の液体逆流の関与が指摘されている。胃酸逆流(pH4未満)に加え、胃酸以外(pH4以上)の液体逆流や空気逆流を捉えるためには、食道pH・多チャンネルインピーダンスモニタリングによる評価が必要となる。PPI倍量投与にもかかわらず逆流症状が持続する患者に対し同検査を施行すると、約34～56%の患者の症状は液体逆流との関連が明らかとなり、その多くは胃酸以外の逆流によるものである。胃酸以外の液体逆流と症状の関連が明らかとなった場合には、逆流症状を改善・消失させるためには、逆流自体を抑制する必要があるが、現状では逆流自体を抑制する薬剤はなく、胃食道逆流症(GERD)診療ガイドラインで示されているように逆流防止術が治療の選択肢の1つとなる。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J01118&link_issn=&doc_id=20100416200002&doc_link_id=1390282681377472640&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390282681377472640&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00535-009-0145-4

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000309483

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10620-008-0542-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00535-009-0070-6

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/j.1440-1746.2006.04726.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/j.1440-1746.2006.04817.x

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記述言語：英語  

Patients with Barrett's esophagus (BE) usually have low resting lower esophageal sphincter (LES) pressure, and also have impaired esophageal body motility, with low amplitude and failed peristaltic contractions on swallowing being common. These motor abnormalities contribute to excessive esophageal acid exposure in patients with BE. However, gastric acid secretion is not different between patients with BE and reflux esophagitis. © 2006 Japan Esophageal Society and Springer-Verlag.

DOI： 10.1007/s10388-006-0090-8

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記述言語：日本語   出版者・発行元：(株)日本医事新報社  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(株)医学出版  

EoEはアレルギー性消化管疾患の1つであり、近年日本で増加傾向にあり注目が集まっている。日本での診断基準は2010年に作成され、2015年に改訂が行われている。つかえ感や胸やけなどの症状を有し、食道粘膜生検で15個以上/HPFの好酸球浸潤を認めることが診断の条件となる。EoEは縦走溝、輪状溝、白色滲出物などの特徴的な内視鏡所見を呈することが多く、内視鏡検査時にこれらの所見を認めた場合はEoEの可能性が高く積極的な生検が望まれる。確定診断には逆流性食道炎や他の好酸球増多疾患を除外する必要がある。食道好酸球浸潤が食道アカラシアなどの食道運動障害の原因と考えられる症例があり、食道の異常強収縮をきたすJackhammer食道の一部では食道筋層のみに好酸球浸潤を認めることがあり、好酸球性食道筋炎と呼ぶ新たな概念も提唱されている。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J02312&link_issn=&doc_id=20220511060011&doc_link_id=%2Faq9syokd%2F2022%2F003404%2F012%2F0560-0566%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faq9syokd%2F2022%2F003404%2F012%2F0560-0566%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床生理学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本潰瘍学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：英語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(株)先端医学社  

わが国ではSSBEが多く、欧米ではLSBEが中心となり、背景は異なるものの、Barrett食道は腺がんの発生母地となるため、注目されている。esophagogastric junction(EGJ)の同定方法の違い、腸上皮化生の有無など各ガイドラインの基準の違いにより、Barrett食道の定義はわが国と欧米では異なるが、内視鏡診断の標準化を目的にプラハ分類が作成されている。欧米においてBarrett食道がんは急速に増加しており、わが国においても今後増加することが懸念されている。表在型Barrett食道腺がんはテント状SSBE類似型、噴門部びらん類似型、EGJポリープ類似型に大別できる。内視鏡診断においては画像強調内視鏡を併用した拡大内視鏡観察の内視鏡診断システムが提唱されている。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J03103&link_issn=&doc_id=20210618330013&doc_link_id=%2Fae6helib%2F2021%2F002501%2F015%2F0067-0070%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae6helib%2F2021%2F002501%2F015%2F0067-0070%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

＜文献概要＞機能性消化管疾患の国際基準であるRome IVのなかで分類されている疾患に機能性胸やけ(functional heartburn)と逆流過敏症(reflux hypersensitivity)がある.食道内酸曝露が正常で逆流と関連した症状があれば逆流過敏症,食道内酸曝露が正常で逆流と関連ない症状であれば機能性胸やけと診断される.両者とも治療に難渋することが多く,臨床ではPPI抵抗性NERDとして扱われている.両者の病態に食道の知覚過敏があり,神経調節物質が治療薬として考えられている.逆流過敏症は逆流防止術も治療の選択肢に挙げられる.エビデンスの高い治療法が少なく,今後は病態の解明とともに有効な薬剤の探索および新規薬剤の開発が求められる.

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(株)医学出版  

PPI抵抗性GERDの存在はGERD診療の問題点の1つであるが、2015年にPPIに比べ酸分泌抑制効果が強力かつ即効性を有するpotassium-competitive acid blocker(P-CAB)であるボノプラザンが登場した。PPI抵抗性GERDの中でPPI抵抗性逆流性食道炎は、強皮症や大きな食道裂孔ヘルニアを有する症例を除くとP-CABにより治癒および寛解維持が可能となった。一方で、PPI抵抗性NERDに関しては酸分泌抑制が不十分な酸逆流で症状を認める患者に対してはP-CABで症状の改善する可能性があるものの、食道の知覚過敏による酸以外の逆流や機能性胸やけが原因の患者においてはP-CABを使用しても症状の改善が得られにくく、P-CAB抵抗性GERDが今後の課題である。NERD患者に対するP-CABの使用は、症状の原因が酸逆流によるものか、酸逆流以外によるものかを判定するP-CABテストとして使用できる可能性があり、今後P-CABのNERD患者への適応が望まれる。(著者抄録)

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞・2015年に登場したカリウムイオン競合型アシッドブロッカー(P-CAB)のvonoprazanは酸分泌抑制力の強さを特徴とし,重症逆流性食道炎やHelicobacter pylori除菌治療などで高い治療効果がある.・vonoprazanの特徴の一つである酸分泌抑制の効果発現の早さを生かした軽症逆流性食道炎に対するオンデマンド療法の有用性が報告されている(vonoprazanのオンデマンド療法は保険適用外).・胃食道逆流症(GERD)診断ツールとしてのプロトンポンプ阻害薬(PPI)テストを上回るP-CABテストの可能性が報告されている(vonoprazanの非びらん性胃食道逆流症(NERD)に対する投与は保険適用外).・vonoprazanの強力な酸分泌抑制作用により高度な高ガストリン血症を引き起こすため,長期使用による安全性の確認が必要である.

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00974&link_issn=&doc_id=20200831070051&doc_link_id=10.15106%2Fj_naika126_540&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_naika126_540&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

2015年にpotassium-competitive acid blocker(P-CAB)であるボノプラザンが登場した。ボノプラザンの特徴は胃酸分泌抑制力の強さと早さである。ボノプラザンの強力な酸抑制は近年増加しているプロトンポンプ阻害薬(PPI)抵抗性逆流性食道炎に対する治療薬として、また胃食道逆流症(GERD)診断ツールとしてのPPIテストを上回るP-CABテストとして期待される。酸分泌抑制の速さに関しては、軽症逆流性食道炎やPPIに反応するNERDに対するon demand療法での維持療法として期待される。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本潰瘍学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)医学出版  

胃食道逆流症(gastroesophageal reflux disease:GERD)の診断は、問診や質問票での評価後、本邦ではまず上部消化管内視鏡検査が行われることが多い。内視鏡検査で粘膜傷害を認めない場合は非びらん性胃食道逆流症(non-erosive reflux disease:NERD)が疑われ、PPI使用にもかかわらず胃食道逆流症状や粘膜傷害が8週間以上遷延する場合には、PPI抵抗性GERDが疑われる。これらの場合、専門施設においては消化管機能検査(食道内圧検査、24時間食道インピーダンス・pHモニタリング)での精査が行われ、それぞれの病態に応じた治療が選択されることとなる。具体的には、PPIの切り替え、消化管運動機能改善薬や漢方薬(六君子湯など)の追加やPPI倍量分割投与(NERDには保険適応外)、P-CABへの変更などが治療選択肢であり、食道内圧検査での一次性食道運動障害の有無、24時間食道インピーダンス・pHモニタリングでの逆流成分の評価(酸逆流、弱酸逆流、アルカリ逆流、空気逆流)に基づいて、治療方針を決定していくこととなる。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(株)医学出版  

アカラシアは、下部食道括約筋の弛緩不全と食道体部の正常蠕動の消失を主病態とし、患者はdysphagia等を訴える著しくQOLを低下させる疾患である。一般的に初期評価として内視鏡検査が行われるが、食道拡張や残渣といった典型的な所見の陽性率は決して高くなく、診断や治療開始の遅れに繋がっていることもある。過去の報告と我々の経験から、3つの内視鏡所見が早期診断に有用であると考える。まず、深吸気時に食道胃接合部の柵状血管の全体像が視認されず、かつ狭小部に向かう放射状の襞を認める所見("Esophageal Rosette")、接合部で柵状血管下端を含めた全体像が視認されず、かつ下部食道の縦断面の形状が内に凸状を呈する所見("Gingko-leaf sign")、最後に食道体部に縦走するスジを認める所見("Pin Stripe Pattern")である。ただ、いずれの所見も多施設前向きでの検討はないため、これらの内視鏡所見に加え、内圧や透視検査を含めて総合的にアカラシア診断をすることが重要である。(著者抄録)

CiNii Research

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その他リンク： https://search.jamas.or.jp/link/ui/2020220758

記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

CiNii Books

CiNii Research

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その他リンク： https://search.jamas.or.jp/link/ui/2020038294

記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

CiNii Research

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その他リンク： https://search.jamas.or.jp/link/ui/2020026138

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

2015年にpotassium-competitive acid blocker(P-CAB)であるボノプラザンが登場した。ボノプラザンの特徴は胃酸分泌抑制力の強さと早さである。ボノプラザンの強力な酸抑制は近年増加しているプロトンポンプ阻害薬(PPI)抵抗性逆流性食道炎に対する治療薬としての期待、胃食道逆流症(GERD)診断ツールとしてのPPIテストを上回るP-CABテストへの期待がある。また酸分泌抑制の速さに関しては、軽症逆流性食道炎やPPIに反応するNERDに対するon demand療法では維持療法への期待がある。いまだボノプラザンに関するデータは少ないが、ボノプラザン使用によって明らかとなってきたGERDの病態もあり、実臨床でのボノプラザンのGERD治療における成績および可能性について概説する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J07014&link_issn=&doc_id=20191024420001&doc_link_id=10.50917%2Fjga.3.1_7&url=https%3A%2F%2Fdoi.org%2F10.50917%2Fjga.3.1_7&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

CiNii Research

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その他リンク： https://search.jamas.or.jp/link/ui/2019163882

記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(公社)日本医師会  

CiNii Books

CiNii Research

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その他リンク： https://search.jamas.or.jp/link/ui/2019112413

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）   出版者・発行元：(株)日本メディカルセンター  

＜文献概要＞胃食道逆流症(GERD)治療の第一選択薬は「GERD診療ガイドライン2015」のなかで記載されているようにプロトンポンプ阻害薬(PPI)であるが,標準量PPIを8週間投与しても食道粘膜傷害が治癒しない,または症状の改善しないPPI抵抗性GERD患者が存在する.標準量PPIで十分な効果が得られない場合の対応の一つとして六君子湯の追加投与がある.六君子湯はこれまで上部消化管のディスペプシア症状に対する有効性が報告されているが,GERDに対する効果も基礎的・臨床的研究により明らかになってきている.また器質的疾患のない咽頭つかえ感に対する半夏厚朴湯,食道の痙攣様収縮や強収縮が原因の嚥下障害に対する芍薬甘草湯の有効性についても報告されており,さらなるエビデンスの集積が必要である.

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)ライフメディコム  

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記述言語：日本語   出版者・発行元：(株)ライフメディコム  

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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(株)じほう  

＜Points＞■消化管粘膜傷害は主に窒素含有のビスホスホネート製剤によって発症する。■ビスホスホネートは起床後空腹時に水180mLと一緒に内服し、服用後少なくとも30分は横にならないように添付文書に記載されている。■ビスホスホネートによる消化管粘膜傷害は薬剤が直接粘膜に接触することで生じるため、経口投与より静脈内投与のほうが消化管粘膜傷害は少ない。■ビスホスホネートとNSAIDsの併用はNSAIDs単独投与に比べ消化性潰瘍発症のリスクが高い。(著者抄録)

J-GLOBAL

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01465&link_issn=&doc_id=20180511300008&doc_link_id=%2Fan1yakgl%2F2018%2F006006%2F011%2F1039-1043%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fan1yakgl%2F2018%2F006006%2F011%2F1039-1043%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

DOI： 10.19020/CG.0000000356

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記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

DOI： 10.19020/CG.0000000356

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01937&link_issn=&doc_id=20180525070017&doc_link_id=10.19020%2FCG.0000000356&url=https%3A%2F%2Fdoi.org%2F10.19020%2FCG.0000000356&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(株)医学書院  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(株)勁草書房コミュニケーション事業部  

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記述言語：日本語   出版者・発行元：(株)勁草書房コミュニケーション事業部  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

裂孔ヘルニアが逆流性食道炎発症の原因である食道内の過剰な酸曝露に及ぼす影響については、必ずしも明確でない。近年、食後の胃内の食事層の上方に出現する酸の層が食後の酸逆流の供給源として注目されている。この酸の層はacid pocketと呼ばれる。Acid pocketが裂孔ヘルニア内に存在する場合には、酸逆流の主なメカニズムである一過性下部食道括約筋(LES)弛緩時に高頻度に酸逆流をともなう。裂孔ヘルニアと食道内酸排出に関しては、常時ヘルニア嚢を有する症例において、ヘルニア内と食道内圧の圧勾配により、ヘルニア内に酸が存在する場合には、嚥下にともない酸がヘルニア内と食道内の移動を繰り返す結果、食道酸排出時間が延長する。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01118&link_issn=&doc_id=20171018100002&doc_link_id=1390001206403086080&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390001206403086080&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

逆流性食道炎における逆流の主なメカニズムは一過性下部食道括約筋(LES)弛緩であり、食道粘膜傷害の原因は食道内の過剰な胃酸曝露である。逆流性食道炎は重症になるに従って食道内の酸曝露時間が有意に増加し、食道内の酸排出が遅延しやすく、また逆流した胃酸は上昇しやすい。逆流性食道炎の内視鏡分類としてロサンゼルス分類が世界的に広く用いられており、その重症度は食道内酸曝露時間や治療反応性との相関が報告され、読影医間の一致率も高く有用であると考えられる。本邦では色調変化型(grade M)を含めた改訂ロサンゼルス分類が用いられている。Grade Mの白濁や発赤が胃酸逆流に伴う所見であることは明らかであるが、色調変化の評価方法や定義が統一されておらず、読影医間の一致率が低いことが問題であり、今後の検討課題である。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜Point＞嚥下障害は,障害の部位により口腔咽頭性嚥下障害と食道性嚥下障害に分けられる.また,原因により器質性嚥下障害と運動性嚥下障害に大別される.医療面接ではつかえる部位,経過(進行性か慢性か),嗄声,構音障害,胸やけ・呑酸の有無,喫煙・飲酒歴,アレルギー歴などを聴取する.身体診察では口腔・咽頭の視診が重要であり,食道病変では身体所見に異常を認めないことが多い.下位脳神経(舌咽・迷走神経)の障害が疑われた場合は耳鼻咽喉科に紹介し,脳血管障害(球麻痺,仮性球麻痺)や神経筋疾患が疑われた場合は神経内科に紹介する.食道病変が疑われた場合は上部消化管内視鏡検査が施行可能な消化器内科に紹介する.(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01440&link_issn=&doc_id=20170512050012&doc_link_id=10.11477%2Fmf.1402224917&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1402224917&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(公社)東京都医師会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

逆流性食道炎は食道内の過剰な酸曝露により発症することから,食道内酸曝露時間を正常にすることにより粘膜傷害は治癒する.逆流性食道炎治療の第一選択薬は「胃食道逆流症(GERD)診療ガイドライン2015」でも推奨されている標準量のプロトンポンプ阻害薬(PPI)である.標準量のPPIを8週間内服することにより,軽症逆流性食道炎患者では約90%,重症逆流性食道炎では80〜85%の内視鏡的治癒が得られると報告されていたが,近年,標準量PPI抵抗性の逆流性食道炎患者が増加している.標準量のPPIにより十分な効果が得られない場合の対応として,生活習慣の見直し,PPIの変更,投与方法(夕食前投与),投与量(倍量分割投与)の変更が有効であることがある.また2015年にはカリウムイオン競合型アシッドブロッカー(P-CAB)が臨床導入された.P-CABの特徴(酸抑制効果が迅速,強力)を生かした,逆流性食道炎治療法の確立が望まれる.(著者抄録)

DOI： 10.19020/J01937.2017115896

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

DOI： 10.19020/J01937.2017059988

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01937&link_issn=&doc_id=20161031120015&doc_link_id=10.19020%2FJ01937.2017059988&url=https%3A%2F%2Fdoi.org%2F10.19020%2FJ01937.2017059988&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

PubMed

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2016372096

記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：医歯薬出版(株)  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00060&link_issn=&doc_id=20160621030010&doc_link_id=issn%3D0039-2359%26volume%3D257%26issue%3D12%26spage%3D1255&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0039-2359%26volume%3D257%26issue%3D12%26spage%3D1255&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)中外医学社  

食道運動障害の診断には食道内圧検査が必須であるが,従来のconventional manometryに代わって,近年,胃近位部から咽頭まで1cm間隔で36個の圧センサーにて測定するhigh resolution manometry(HRM)法が開発された.HRMは多数の圧センサーを有し,従来のconventional manometryより詳細な食道運動機能の評価が可能であり,多チャンネルの圧データをカラープロットに変換可能で視覚的にも捉えやすくなっている.HRMを解析するためには従来の測定法と異なる新しいパラメーターが必要であり,そのパラメーターに基づく新たな食道運動障害の分類-シカゴ分類が発表された.2009年に最初のシカゴ分類が発表され,その後3年おきに改訂が行われ,現在の最新版は2015年のv3.0である.より完成度の高い分類に改訂されているがまだ課題も残されている.食道内圧検査はこれまでは一部の専門施設でのみ行われている状況であったが,HRMの開発により本邦でも新たにHRMを導入する施設が増えてきた.HRMの診断法や問題点をよく理解した上で誤った診断とならないよう注意が必要である.(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)ライフ・サイエンス  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

本邦における逆流性食道炎(RE)の内視鏡診断は色調変化型を含めた改訂Los Angeles(LA)分類が広く利用されている。食道粘膜傷害の診断は白苔がある場合や発赤が鮮明で境界が明瞭な場合は容易であるが、発赤だけの場合は深吸気時に送気を行いながら下部食道を十分に伸展し観察することが大切である。粘膜傷害の読影医間の診断の一意率は高い。しかし、色調変化型(発赤、白濁)の読影医間の診断一致率は低く、その原因として色調変化の評価方法、定義が統一されていないことがあげられる。白濁の定義としては十分に下部食道を伸展した状態において柵状血管が透見できない状態であるが、その範囲に関しては基準がなく、今後の検討課題である。REは食道内の過剰な酸暴露により発症することから、食道内酸暴露時間を正常にすることにより粘膜傷害は治癒する。REの治療は標準量のプロトンポンプ阻害薬(PPI)の内服により軽症REの90-95%、重症REの80-85%が治癒する。標準量のPPIにより十分な効果が得られない場合の対応として、PPIの変更、投与方法(夕食前摂取)の変更が有効である場合がある。(著者抄録)

DOI： 10.11280/gee.57.1641

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00192&link_issn=&doc_id=20150902120010&doc_link_id=10.11280%2Fgee.57.1641&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.57.1641&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

記述言語：日本語   出版者・発行元：(株)日本臨床社  

PubMed

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2015260007

記述言語：日本語   出版者・発行元：(株)日本臨床社  

PubMed

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2015260023

記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：医歯薬出版(株)  

非びらん性胃食道逆流症(NERD)における酸逆流のメカニズム・酸上昇パターンは、これまで明らかになっていない。著者らは、NERD、健常人、軽症逆流性食道炎(RE)を対象として食前15分・食後3時間の食道内圧・pHモニタリング同時測定を行い、酸逆流のメカニズム、酸上昇パターンを検討した。結果、3群ともに一過性LES弛緩が酸逆流のメカニズムであることが明らかとなった。また、一過性LES弛緩時に酸逆流を合併する頻度はLES口側2cmでは有意差を認めなかったが、LES口側7cmではNERDは軽症RE、健常人に比べ有意に高率であった。これよりNERDでは、逆流した胃酸が健常人や軽症REに比べ口側に上昇しやすいことがわかった。NERDの病態は、酸逆流に加え、食道知覚過敏、食道運動異常、心理的要因など多要因が病態形成にかかわっていると考えられている。NERDでは食道粘膜知覚過敏が基本に存在し、加えて上方の食道へ逆流液が上昇しやすいために、胸やけ・逆流症状が発現しやすい状況であると思われる。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00060&link_issn=&doc_id=20150209020002&doc_link_id=%2Faa7ayuma%2F2015%2F025206%2F003%2F0663-0667%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa7ayuma%2F2015%2F025206%2F003%2F0663-0667%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(有)科学評論社  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2015072790

記述言語：日本語   出版者・発行元：日本医科大学医学会  

DOI： 10.1272/manms.10.182

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J04260&link_issn=&doc_id=20141024470005&doc_link_id=%2Fcw1nimed%2F2014%2F001004%2F006%2F0182-0185%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2014%2F001004%2F006%2F0182-0185%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)診断と治療社  

1.胃食道逆流症(GERD)は食道に粘膜傷害を有する逆流性食道炎と逆流症状のみを有する非びらん性胃食道逆流症(NERD)に分類されるが、GERDの約70%はNERDである。2.GERD患者の日常生活の質(QOL)は低下し、急性期十二指腸潰瘍患者と同様であるが、適切な治療により健常者レベルに戻る。3.標準量のプロトンポンプ阻害薬(PPI)使用により、ほとんどの軽症逆流性食道炎、80〜85%の重症逆流性食道炎は治癒する。4.NERD患者での標準量PPIでの症状改善率は約半数である。この原因として、胃酸以外の逆流、食道運動異常症、好酸球性食道炎、精神心理学的因子等が考えられている。(著者抄録)

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2014312054

記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(株)新興医学出版社  

1 バルーン拡張術は、低圧でゆっくり加圧することが安全かつ有効に行うために重要である。2 40歳以上のアカラシア患者では、バルーン拡張術の成績は良好であり、バルーン拡張術の最も良い適応と考えられる。3 30歳未満の症例ではバルーン拡張術有効例は無く、外科的治療が第一選択と考えられる。4 繰り返すバルーン拡張術は、外科的治療の妨げとなるため、2コースまでが適当である。5 High-resolution manometryによるアカラシアの新分類(Chicago分類)は今後のアカラシア診療に有用である可能性が高い。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)東京医学社  

わが国にはSSBEが多く、Barrett腺癌はSSBEに生じるものが多い。したがって、SSBEの内視鏡診断の確実性が求められる。EGJの内視鏡的landmarkとして、(1)柵状縦走血管下端、(2)胃粘膜ひだ上縁の2種類が使用されている。わが国では「柵状縦走血管下端」を、欧米では「胃粘膜ひだ上縁」をlandmarkとしているものが多い。これらを使用して診断されたBarrett食道(BE)の診断一致率には差があり、精度の向上が求められている。EGJの判定条件をもっと厳格にし、その診断法の衆知に努めることが極めて重要である。わが国と異なり、英国を除く欧米では、腸上皮化生を伴っていることがBEの必要条件であった。しかし、最近このような考え方に疑問を呈する研究者によって再考すべきとの意見が出ている。また、組織学的にも粘膜固有層に100μm以上の径を有する血管が存在すれば、それは柵状縦走血管であるという新しい診断基準も提示され、Barrett粘膜のサーベイランスの考え方や方法にも大きな変化が生じている。(著者抄録)

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(株)ライフメディコム  

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記述言語：日本語   出版者・発行元：(株)先端医学社  

食道痙攣症は、食道運動異常症の代表的疾患の1つであり、原因不明な「胸痛」、「嚥下困難」を有する患者の鑑別診断として重要である。食道内圧検査では正常な食道蠕動波に加え、間欠的な食道同期性収縮波を認める。同期性収縮波出現の原因としては、内因性一酸化窒素(NO)の合成・分解が関与していると考えられている。食道痙攣症の内視鏡検査ではらせん状収縮、また食道造影検査においてもらせん状収縮、数珠状収縮を有することがある。症状の程度、頻度、持続時間はさまざまである。症状出現の原因を説明することや食事摂取の生活指導をおこなうことにより、薬物療法をおこなうことなく経過観察をおこなうことができる患者がほとんどであるが、強い症状のためquality of life(QOL)が著しく損なわれる場合には、外科的に食道筋層切開術がおこなわれることもある。(著者抄録)

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記述言語：日本語   出版者・発行元：日本臨床生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(株)新興医学出版社  

逆流性食道炎は食道内の過剰な胃酸曝露により発症する。胃酸逆流の重要な3つのメカニズムは、(1)一過性LES弛緩、(2)free reflux、(3)strain refluxである。健常者、逆流性食道炎患者の胃酸逆流の主なメカニズムは一過性LES弛緩である。健常者、逆流性食道炎患者ともにLES直上では頻回な胃酸逆流が発生している。逆流性食道炎が重症になるに従い、食道内に逆流した胃酸は口側へ上昇しやすい。重症逆流性食道炎患者では食道排出能が低下している。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(株)新興医学出版社  

食道アカラシアの病態の本質は下部食道括約筋(LES)弛緩不全である。食道拡張を認めないアカラシア患者では、長期に診断が行われず放置されている場合がある。つかえ感を有する患者では常にアカラシアの存在を念頭におき診療を行うことが重要である。アカラシアの診断には、食道内圧検査、内視鏡検査、食道造影検査が有用であるが、確定診断は食道内圧検査により行われる。バルーン拡張術は、低圧でゆっくり加圧することが安全かつ有効に行うために重要であり、40歳以上のアカラシア患者に対する有効率は80%以上である。(著者抄録)

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

胃食道逆流症と睡眠障害の関連性が注目されている。夜間胃酸逆流の主な発生機序は日中と同様に一過性下部食道括約筋(LES)弛緩時に発生するが、夜間胃酸逆流発生後の胃酸排出機序は日中とは異なり、二次蠕動波が重要である。しかし、非びらん性胃食道逆流症患者や逆流性食道炎患者では二次蠕動波の出現率は健常者に比べ低下しており、夜間胃酸逆流が発生すると胃酸が長時間食道内に停滞すると同時に、逆流症状をおこしやすい上部食道に胃酸が達するため、逆流症状が出現し睡眠障害をおこす可能性がある。また一過性LES弛緩発生時の睡眠状態は覚醒時または浅い睡眠状態であり、睡眠障害自体が夜間逆流を誘発している可能性もある。(著者抄録)

DOI： 10.11405/nisshoshi.110.971

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J01118&link_issn=&doc_id=20130613240003&doc_link_id=1390282681378469248&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390282681378469248&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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