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  

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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)東京医学社  

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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)東京医学社  

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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  

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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：(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）  

BACKGROUND: Linked color imaging (LCI) improves detection of colorectal neoplastic lesions during colonoscopy. However, polyps <5 mm in diameter often do not require resection, and the benefits of LCI are unclear for detection of colorectal polyps ≥5 mm that are indicated for endoscopic resection in clinical practice. This randomized controlled trial compared rates of detection of adenoma polyps, stratified by size, for LCI and white light imaging (WLI). METHODS: We compared ADR (5 mm-) and PDR (5 mm-), which were defined as the proportion of patients with at least one adenoma or polyp with a diameter of 5 mm or larger in the LCI and WLI groups. Moreover, we estimated ADR and PDR for diameters between 5 and 10 mm (ADR (5-9 mm), PDR (5-9 mm) ) and for diameters larger than 10 mm (ADR (10 mm-), PDR (10 mm-) ). RESULTS: Data from 594 patients (LCI, n=305; WLI, n=289) were analyzed. ADR (5 mm-) and PDR (5 mm-) were significantly higher in the LCI group than in the WLI group (ADR (5 mm-): P=0.016, PDR (5 mm-): P=0.020). In the assessment of adenoma and polyp size, ADR (5-9 mm) and PDR (5-9 mm) were significantly higher in the LCI group than in the WLI group, although no significant differences were seen in ADR (10 mm-) and PDR (10 mm-) between these groups. CONCLUSIONS: Polyps ≥5 mm, which are indicated for endoscopic treatment, were more easily visualized with LCI mode than with WLI mode. The improvement in detection rate was obvious for polyps <10 mm, which are easier to miss.

DOI： 10.1272/jnms.JNMS.2023_90-117

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The frequency of primary small intestinal adenocarcinoma is increasing but is still low. Its frequency is approximately 3% of that of colorectal adenocarcinoma. Considering that the small intestine occupies 90% of the surface area of the gastrointestinal tract, small intestinal adenocarcinoma is very rare. The main site of small intestinal adenocarcinoma is the proximal small intestine. Based on this characteristic, dietary animal proteins/lipids and bile concentrations are implicated and reported to be involved in carcinogenesis. Since most nutrients are absorbed in the proximal small intestine, the effect of absorbable intestinal content is a suitable explanation for why small intestinal adenocarcinoma is more common in the proximal small intestine. The proportion of aerobic bacteria is high in the proximal small intestine, but the absolute number of bacteria is low. In addition, the length and density of villi are greater in the proximal small intestine. However, the involvement of villi is considered to be low because the number of small intestinal adenocarcinomas is much smaller than that of colorectal adenocarcinomas. On the other hand, the reason for the low incidence of small intestinal adenocarcinoma in the distal small intestine may be that immune organs reside there. Genetic and disease factors increase the likelihood of small intestinal adenocarcinoma. In carcinogenesis experiments in which the positions of the small and large intestines were exchanged, tumors still occurred in the large intestinal mucosa more often. In other words, the influence of the intestinal contents is small, and there is a large difference in epithelial properties between the small intestine and the large intestine. In conclusion, small intestinal adenocarcinoma is rare compared to large intestinal adenocarcinoma due to the nature of the epithelium. It is reasonable to assume that diet is a trigger for small intestinal adenocarcinoma.

DOI： 10.3748/wjg.v28.i39.5658

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Small bowel adenocarcinomas (SBAs) are rare and there is little comprehensive data on SBA genomic alterations for Asian patients. This study aimed to profile genomic alterations of SBA in Japanese patients using targeted next-generation sequencing (NGS). METHODS: We examined 22 surgical resections from patients with primary SBA. SBA genomic alterations were analyzed by NGS. Mismatch repair (MMR) status was determined by immunohistochemical analysis. Mucin phenotypes were classified as gastric (G), intestinal (I), gastrointestinal (GI), and null (N) types on MUC2, MUC5AC, MUC6, and CD10 immunostaining. RESULTS: The most common genomic alterations found in SBA tumors were TP53 (n = 16), followed by KRAS (n = 6), APC (n = 5), PIK3CA (n = 4), CTNNB1 (n = 3), KIT (n = 2), BRAF (n = 2), CDKN2A (n = 2), and PTEN (n = 2). Deficient MMR tumors were observed in 6 out of 22 patients. Tumor mucin phenotypes included 2 in G-type, 12 in I-type, 3 in GI-type, and 5 in N-type. APC and CTNNB1 mutations were not found in G-type and GI-type tumors. KRAS mutations were found in all tumor types except for G-type tumors. TP53 mutations were found in all tumor types. Although no single gene mutation was associated with overall survival (OS), we found that KRAS mutations were associated with significant worse OS in patients with proficient MMR tumors. CONCLUSIONS: SBA genomic alterations in Japanese patients do not differ significantly from those reports in Western countries. Tumor localization, mucin phenotype, and MMR status all appear to impact SBA gene mutations.

DOI： 10.1186/s12885-022-09824-6

PubMed

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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：(株)日本メディカルセンター  

＜文献概要＞クローン病の治療法を決めるには病型や病勢評価が重要であり,小腸検査は欠かせない.カプセル内視鏡は簡便かつ患者の負担が少ない小腸内視鏡検査として本邦で広く使用され,クローン病にも使用されている.カプセル内視鏡は病変部の能動的な詳細観察ができないが,病変が多発し,病変に長さがあるクローン病では病変の検出に関する問題は少ない.とくに病初期・軽度小腸病変の経過観察においてカプセル内視鏡の有用性は高いと考えられている.ただし,腸管に狭窄を合併しやすいクローン病では,カプセルが狭窄部位に滞留する可能性が高く注意が必要であり,クローン病にカプセル内視鏡を使用する場合にはパテンシーカプセルによる消化管通過試験を事前に行う必要がある.

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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  

症例は63歳男性で、肺扁平上皮癌に対しペムブロリズマブを計31コース施行し部分奏功を維持していたが、開始から23ヵ月後より下痢を認め、32コース目を中止し入院した。入院時検査所見で軽度炎症反応上昇を認め、下部消化管内視鏡検査および病理組織所見で潰瘍性大腸炎に類似する所見を認めたことから、ペムブロリズマブによる免疫関連副作用(irAE)大腸炎と診断した。プレドニゾロンにより症状は軽快したが、漸減中に誤嚥性肺炎を合併し抗菌薬加療を行った。第70病日に偽膜性腸炎とCMV腸炎を同時合併し、メトロニダゾールおよびガンシクロビルにより症状改善を認めた。第105病日にirAE大腸炎を再燃したが軽症であり、メサラジンによる維持治療で半年経過している。

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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=J04450&link_issn=&doc_id=20201225120035&doc_link_id=130007966563&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007966563&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.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-関東支部  

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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：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：(株)東京医学社  

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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：日本小腸学会  

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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：日本小腸学会  

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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)日本大腸肛門病学会  

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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：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Immune checkpoint inhibitors (ICIs) can induce immune-related adverse events (irAEs) including thyroid dysfunction. There are only a few reports on Graves' disease induced by ICIs. We report a case of new-onset Graves' disease after the initiation of nivolumab therapy in a patient receiving gastric cancer treatment. CASE PRESENTATION: The patient was a 66-year-old Japanese man, who was administered nivolumab (240 mg every 3 weeks) as a third-line therapy for stage IVb gastric cancer. His thyroid function was normal before the initiation of nivolumab therapy. However, he developed thyrotoxicosis before the third administration of nivolumab. Elevated, bilateral, and diffuse uptake of radioactive tracer was observed in the 99mTc-pertechnetate scintigraphy. Furthermore, the thyroid-stimulating hormone receptor antibody (TRAb) and thyroid-stimulating antibody (TSAb) test results, which were negative before the first administration of nivolumab, were positive after starting the therapy. The patient was diagnosed with Graves' disease, and the treatment with methimazole and potassium iodide restored thyroid function. CONCLUSIONS: This is the first complete report of a case of new-onset Graves' disease after starting nivolumab therapy, confirmed by diffusely increased thyroid uptake in scintigraphy and the positive conversion of antibodies against thyroid-stimulating hormone receptor. It is important to perform thyroid scintigraphy and ultrasonography to accurately diagnose and treat ICI-induced thyrotoxicosis, because there are various cases in which Graves' disease is developed with negative and positive TRAb titres.

DOI： 10.1186/s12902-020-00613-5

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 AIMS: Small intestinal lesions in patients with Behçet disease (BD) have a risk of perforation and hemorrhage requiring surgery. However, no screening strategy for such lesions has been established. We investigated small intestinal lesions in BD patients with video capsule endoscopy (VCE) and analyzed clinical characteristics to identify noninvasive biomarkers of such lesions. METHODS: This study included 33 BD patients who underwent VCE (PillCam® SB3) at our institution from June 2016 to January 2019. Clinical characteristics, including age, sex, disease duration, body mass index, gastrointestinal symptoms, eye involvement, and blood examinations, were obtained from the medical records of 27 of the 33 patients. Fecal immunochemical tests for hemoglobin, fecal calprotectin (FC), and fecal lactoferrin (FL) were measured. VCE findings of 145 healthy Japanese individuals from a previous report were used as controls. RESULTS: Two intestinal BD patients were included in the 27 patients. We observed that BD patients exhibit more small intestinal lesions compared with healthy individuals, including erosions, ulcers, and total lesions (erosions or ulcers). FC and FL levels were significantly higher in patients with versus without small intestinal lesions (P = 0.034 and P = 0.046, respectively). Receiver operating characteristic analyses demonstrated that FC (cutoff value = 119 μg/g) and FL (cutoff value = 17 μg/g) were biomarkers for small intestinal lesions in patients with BD. CONCLUSION: The present study using VCE showed that patients with BD had more small intestinal lesions than healthy individuals. FC and FL could be useful for screening BD patients who may have small intestinal lesions.

DOI： 10.1111/jgh.14995

PubMed

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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  

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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)日本臨床社  

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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）  

DOI： 10.1016/j.vgie.2019.10.009

PubMed

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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：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)日本大腸肛門病学会  

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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: There is considerable individual variability in nonsteroidal anti-inflammatory drug (NSAID)-induced enteropathy. AIM: To identify the SNP that is most significantly involved with NSAID-induced enteropathy. METHODS: One hundred fifty human subjects who were known to have a certain degree of loxoprofen- or celecoxib-induced small-intestinal damage from a previous study were enrolled. The subjects were divided into groups based on treatments and also on the increased number of small intestinal mucosal breaks. The candidate SNP was selected by an initial analysis of GWAS among the groups in various combinations. After the initial analysis, the gene including the specified SNP was analyzed in detail using GWAS and genotype imputation. RESULTS: After analysis, 70 subjects receiving the loxoprofen treatment and 69 subjects receiving celecoxib treatment were determined to be eligible for the analysis. The minimum p value in GWAS was detected in the analysis of 16 cases with an increase of five or more mucosal breaks and 123 controls with zero to four mucosal breaks. In the GWAS, five SNPs in the bactericidal/permeability-increasing fold-containing family B member 4 (BPIFB4) gene showed the lowest p value (p = 2.69 × 10-7 with an odds ratio of 40.9). Of the five SNPs, four were nonsynonymous SNPs (rs2070325: V268I, rs2889732: T320N, rs11699009: F527L, rs11696307: T533I, and rs11696310: intronic). Furthermore, 23 SNPs in BPIFB4 detected by genotype imputation based on the GWAS data also showed suggestive associations (p < 1 × 10-6). CONCLUSION: The results indicate that SNPs in BPIFB4 were associated with NSAID-induced small intestinal mucosal injury (UMIN: 000007936).

DOI： 10.1007/s10620-018-5349-0

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Nowadays, interferon-free direct-acting antiviral (DAA) treatment is the standard of care for chronic hepatitis C patients. Some DAA regimens are highly effective and safe even for those with renal dysfunction/failure including those receiving HD. However, it remains unclear to what extent HD specialists gain knowledge about advances in anti-hepatitis C virus (HCV) treatment. To clarify the current situation and identify problems in the treatment of HD patients with chronic hepatitis C, we performed a questionnaire survey at 36 HD facilities between June 2016 and September 2017. In a total of 3418 HD patients, 179 (5.2%) were positive for anti-HCV antibody, and among these patients, 110/125 (88.0%) were positive for serum HCV RNA. Of the latter, only 42/110 (38.2%) patients received antiviral therapy. Moreover, HCV serotyping or genotyping was performed in 23/110 (20.9%) patients. In 26/49 (53.1%) of the remaining 68 untreated patients, "HD specialists do not know any HCV-specific treatments" and "HD specialists have no opportunity to consult with a hepatologist" were the reasons cited for the lack of anti-HCV treatment. This epidemiological study found that some HD patients with chronic hepatitis C had not yet received antiviral treatment despite the emergence of DAAs. To overcome such undesirable circumstances, medical cooperation between HD specialists and hepatologists should be required.

DOI： 10.1111/1744-9987.12747

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. As a result, patients with colonic diverticular disease are often bothered by required frequent examinations, re-hospitalization, and a consequent decrease in quality of life. However, the management of diverticular disease differs between Japan and Western countries. For example, computed tomography (CT) is readily accessible at Japanese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular disease. Endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding. Administration of antibiotics and complete bowel rest may be considered as first-line therapy for colonic diverticulitis. In addition, diverticula occur mainly in the sigmoid colon in Western countries, whereas the right side or bilateral of the colon is more commonly involved in Japan. As such, diverticular disease in the right-side colon is more prevalent in Japan than in Western countries. Against this background, concern is growing about the management of colonic diverticular disease in Japan and there is currently no practice guideline available. To address this situation, the Japanese Gastroenterological Association decided to create a clinical guideline for colonic diverticular bleeding and colonic diverticulitis in collaboration with the Japanese Society of Gastroenterology, Japan Gastroenterological Endoscopy Society, and Japanese Society of Interventional Radiology. The steps taken to establish this guideline involved incorporating the concept of the GRADE system for rating clinical guidelines, developing clinical questions (CQs), accumulating evidence through a literature search and review, and developing the Statement and Explanation sections. This guideline includes 2CQs for colonic diverticulosis, 24 CQs for colonic diverticular bleeding, and 17 CQs for diverticulitis.

DOI： 10.1159/000495282

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: Helicobacter pylori infection is a primary cause of gastroduodenal ulcers. To investigate whether there is an association between H. pylori infection and small intestinal mucosal injury. METHODS: Patients were selected from a general pool of subjects who underwent capsule endoscopy for current or past obscure gastrointestinal bleeding. Characteristics including age, gender, history, treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and/or acid suppressant, diagnosis, and H. pylori infection were investigated. Patients infected with H. pylori had positive test result, ranging 30 days before to 30 days after capsule endoscopy. Patients diagnosed with inflammatory diseases, malignant tumors, etc. were excluded. All video images were re-evaluated to count small intestinal mucosal breaks. Eligible patient variables were compared. RESULTS: A total of 92 patients (30 infected with H. pylori/62 uninfected) were eligible. By univariate analysis of the number of mucosal breaks, patients treated with NSAIDs were found to have more mucosal breaks than patients untreated (38%: 8/21 vs. 18%: 13/71; p = 0.004), and the possible association was detected between patients infected with H. pylori and those who were not (67%: 14/21 vs. 37%: 26/71; p = 0.081). When comparing the H. pylori infected and uninfected patients, the rate of patients with mucosal breaks was greater in infected patients (47%: 14/30 vs. 11%: 7/62; p = 0.001). After excluding patients treated with NSAIDs, the number of mucosal breaks was also greater in patients infected with H. pylori (1.2 ± 1.5 vs. 0.38 ± 0.62; p = 0.001). CONCLUSION: There is a possibility that H. pylori infection induces small intestinal mucosal injury.

DOI： 10.1159/000494415

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: Few reports have demonstrated the effectiveness of treatments for intestinal follicular lymphoma (FL) because of the limited number of patients who undergo comprehensive small intestinal examinations. This study compared the efficacy of rituximab-combined chemotherapy in patients with asymptomatic and low tumor burden (LTB) intestinal FL, according to the criteria of the Groupe d'Etude des Lymphomes Folliculaires, with that of a "watch and wait" (W&W) approach. METHODS: The endoscopic examination for entire gastrointestinal tracts was performed in 29 Japanese patients with intestinal FL. These patients had CD21-positive follicular dendritic cells arranged in a duodenal pattern. In a prospective, two-center, open-label trial, this study evaluated the efficacy of rituximab-combined chemotherapy ([cyclophosphamide, doxorubicin, vincristine, and prednisone] or [cyclophosphamide, vincristine, and prednisone]) and prolonged treatment with rituximab (R-Chemo+prolongedR) in 14 patients and compared their outcomes with those of 15 patients managed with a W&W approach. RESULTS: Four patients managed with the W&W plan showed worsening macroscopic findings, lesion area enlargement, or clinical stage progression but stayed on this plan because they had LTB and experienced no changes in bowel function. In the R-Chemo+prolongedR group, all patients achieved complete remission; recurrence occurred in one patient, who was subsequently managed with the W&W plan because of LTB. There were no significant differences in progression-free survival between the two groups (P = 0.1045). Overall survival was 100% in both groups. CONCLUSIONS: The prognoses of patients with asymptomatic intestinal FL and LTB who were managed with a W&W strategy were comparable with those of patients receiving R-Chemo+prolongedR.

DOI： 10.1111/jgh.14100

PubMed

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記述言語：日本語   出版者・発行元：日本腹部救急医学会  

2017年12月日本消化管学会が主幹となり関連学会と共同で大腸憩室症ガイドライン（憩室出血，憩室炎）を発表した。大腸憩室出血のkey statementを概括した。本邦では大腸憩室の保有率が上昇し，大腸憩室出血は増加している。大腸憩室出血は70～90％で自然止血し，再出血率も20～40%と高率である。大腸憩室出血の診断には止血術も可能な大腸内視鏡が推奨される。クリップ止血法では，出血点を直接把持する直達法に比べ，憩室口をふさぐ縫縮法で再出血率が高い傾向にある。出血憩室を機械的に結紮する憩室結紮法は，クリップ法に比して動脈塞栓術や外科手術への移行率が低い。憩室結紮法では少数例だが遅発性腸管穿孔も報告されている。再出血の予防にはNSAIDsと一次予防アスピリン内服中止を検討する。

DOI： 10.11231/jaem.38.807

CiNii Research

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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：Blackwell Publishing  

BACKGROUND AND AIM: Although several drugs may induce small-bowel mucosal injuries, it is unclear whether these injuries contribute to overt small-bowel bleeding. This study was designed to evaluate the associations between drug use and small-bowel mucosal injury and between these mucosal injuries and overt bleeding in a disease-relevant population. METHODS: We retrospectively studied patients with suspected small-bowel diseases who underwent capsule endoscopy between 2010 and 2013. Drug exposure, Charlson Comorbidity Index, smoking, and alcohol consumption were assessed before capsule endoscopy. Adjusted odds ratios (AOR) and confidence intervals (CI) were estimated for small-bowel mucosal injury and small-bowel overt bleeding. RESULTS: In total, 850 patients were analyzed during the study period. Median age was 64 years, and 544 patients (64.0%) were men. Among the patients with small-bowel mucosal injury (n = 60) and without mucosal injury (n = 705), use of non-steroidal anti-inflammatory drugs (NSAIDs) (AOR 1.8, 95% CI 1.01-3.31) was significantly associated with an increased risk of small-bowel mucosal injury compared with non-use. Patients with small-bowel mucosal injury with overt bleeding (n = 85) and without overt bleeding (n = 60) were compared, and no significant difference between the groups in the usage rates for NSAIDs, thienopyridine, other antiplatelets, anticoagulants, acetaminophen, tramadol hydrochloride, or steroids was revealed, even after adjusting for confounders. CONCLUSION: Although the use of NSAIDs was significantly associated with an increased risk of small-bowel mucosal injury, no significant associations were observed between the use of such drugs and small-bowel overt bleeding.

DOI： 10.1111/den.12922

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記述言語：日本語   出版者・発行元：日本小腸学会  

【目的】

Peutz-Jeghers症候群（PJS) は大きな有茎性ポリープを切除することが腸重積の予防に非常に有効である．ダブバルーン小腸内視鏡（DBE）でのクロスドクリップ法によるポリープ切除は，ポリープ数の増加，偶発症の減少が見込める．一方で大きなポリープは癌化することがあるため，ポリペクトミー後の検体回収が必要になる．さらにPJSは開腹歴の既往のためDBE挿入困難例で長時間の検査が多い為，安全で確実なDBE処置が求められる．

【方法】

2006年6月より2018年9月までに，DBEを施行したPJS12例，全検査37件を分析し，クロスドクリップ併用群と非併用群に分けて後ろ向きに比較し，当科におけるPJSの小腸ポリープ切除の特徴を遡及的に検討した．

【結果】

男性4例，女性８例．初回検査時の平均年齢は34.7(16-64) 歳，12例中開腹歴があったのは11例で，そのうち10例で癒着高度のため挿入困難であった．DBEによる小腸ポリープ切除施行例が10例（クロスドクリップ併用4例），2例は観察のみであった．全小腸が観察可能であったのは，13例中9例で，全小腸の平均挿入時間（検査時間）は122分（207分）であった．ポリープ切除10例中クロスドクリップ併用群4例の平均ポリープ処置数は17.5個，非併用群6例の平均ポリープ切除数3.5個であった．合併症に関しては，6例で高度の出血が見られたが，いずれもクロスドクリップ非併用群であった．

【結論】

PJSに対する内視鏡的ポリープ切除では，クロスドクリップを併用することで，より多くのポリープ処置が安全に可能であった．

DOI： 10.32264/shocho.2.0_38

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: There are no reports to prove the repeatability of gastric transit time (GTT) and small bowel transit time (SBTT) in capsule endoscopy (CE). OBJECTIVE: To clarify the repeatability and factors that affect GTT/SBTT in CE. METHODS: We analyzed the data of 150 healthy subjects from our previous randomized controlled trial that compared small intestinal injuries between two 14-day treatment groups: 1) celecoxib and 2) loxoprofen + lansoprazole. Correlation of GTT/SBTT with pre- and post-treatment CE was analyzed. In addition, the associations of pre-treatment CE SBTT with physical factors, post-treatment CE SBTT and the presence of small intestinal mucosal injuries were analyzed. RESULTS: Analyses of 148 subjects pre-treatment CE and 146 subjects post-treatment CE were performed. There were no significant differences between mean GTT and SBTT before and after treatment. Both GTT (𝜌 = 0.22, p < 0.01) and SBTT (𝜌 = 0.47, p < 0.0001) showed positive correlations between pre- and post-treatment CE. In pre-treatment CE, physical factors and the presence of small intestinal mucosal injury had no associations with SBTT. CONCLUSIONS: Moderate correlation in SBTT and slight correlation in GTT were shown on repeated CE. The factors affecting SBTT were not clarified in this analysis.

DOI： 10.3233/BME-181027

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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：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PUBLIC LIBRARY SCIENCE  

BACKGROUND: Previous studies have reported that the suppression of acid secretion by using proton pump inhibitors (PPIs) results in dysbiosis of the small-bowel microbiota, leading to exacerbated small-bowel injuries, including erosions and ulcers. This study was designed to assess the association between PPI therapy and small-bowel lesions after adjustment for the differences in baseline characteristics between users and non-users of PPIs. METHODS: We retrospectively studied patients suspected to be suffering from small-bowel diseases, who underwent capsule endoscopy between 2010 and 2013. We used propensity matching to adjust for the differences in baseline characteristics between users and non-users of PPIs. The outcomes included the prevalence of small-bowel lesions: erosion, ulcer, angioectasia, varices, and tumor. RESULTS: We selected 327 patient pairs for analysis after propensity matching, and found no significant differences in the prevalence of small-bowel injuries, including erosions and ulcers, between users and non-users of PPIs. Two subgroup analyses of the effect of the type of PPI and the effect of PPI therapy in users and non-users of nonsteroidal anti-inflammatory drugs indicated no significant differences in the prevalence of small-bowel injuries in these two groups. CONCLUSION: PPI therapy did not increase the prevalence of small-bowel injury, regardless of the type of PPI used and the use of nonsteroidal anti-inflammatory drugs.

DOI： 10.1371/journal.pone.0182586

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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：ELSEVIER IRELAND LTD  

A 73-year-old man with a suspected ileus in January 2013 and subsequently suffered melena in February 2014 was endoscopically examined. As a result of the examinations, unidentified species of Corynosoma sp. and Corynosoma villosum were recovered from the small intestine, further endoscopic diagnosis suggested relevance between abdominal pain and the present infections in the small intestine. The recovered worms were composed of gravid females with developed eggs, suggesting that these parasites can survive for a long time in the intestine after infection. In this case, the short interval between infections appears to be due to the individual's eating habits which consist of regularly consuming uncooked seafood.

DOI： 10.1016/j.parint.2016.07.002

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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：TAYLOR & FRANCIS LTD  

OBJECTIVE: There is no consensus regarding the best treatment for intestinal follicular lymphoma (FL). We used "watch and wait" for patients with intestinal FL with low-tumor-burden (LTB) criteria and without mass formation causing bowel obstruction. We investigated the overall survival (OS) and time to treatment required (TTR). METHODS: Thirty-three intestinal FL patients [clinical stage (CS) I:16, II1:0, II2:7, IV:10; median observation period: 45.5 months, range: 13-110 months] were diagnosed via endoscopy. Detailed clinical and pathological examinations were performed, and neoplastic process behavior was monitored. RESULTS: All of the 33 patients were WHO grade 1. FL lesions in the digestive tract were found frequently in the second-fourth portion of the duodenum in 91% of the patients; 87% of those patients had lesions in a broader area including the small intestine. Two patients had an enlargement of the area of the lesions and a worsening of the macroscopic findings. Three patients had CS progression; however, these remained within the indication for "watch and wait." Two patients with transformation into diffuse large B-cell lymphoma received rituximab and chemotherapy, which led to complete remission. The OS was 100%. The time to treatment required (TTR) was 49 months in one patient and 37 months in one patient. CONCLUSION: Intestinal FL in CS I-IV with broad infiltration of the digestive tract meeting the criteria for LTB had a remarkably slow course. This study suggests that "watch and wait" is appropriate for the treatment of LTB intestinal FL even in the era of rituximab.

DOI： 10.3109/00365521.2015.1087589

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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：LIPPINCOTT WILLIAMS & WILKINS  

GOALS: The aim of this study was to compare celecoxib with loxoprofen for protection of small intestine. BACKGROUND: RCT studies report that COX-2 selective inhibitor celecoxib induces fewer small intestinal injuries than nonselective nonsteroidal anti-inflammatory drugs (NSAIDs). Loxoprofen is a prodrug nonselective NSAID developed to protect upper gastrointestinal tract. STUDY: A total of 150 healthy volunteers (40 to 70 y) were enrolled. After medical checkup including laboratory data, subjects were randomly assigned to celecoxib (200 mg daily) or loxoprofen (180 mg daily) plus lansoprazole (15 mg daily). All drugs were prepared using inactive capsules. After randomization, all subjects were first examined by baseline capsule endoscopy (CE). After 14 days, subjects underwent posttreatment CE. We compared baseline and posttreatment CE findings of the 2 groups. All CE data were evaluated blindly by 3 reviewers. Pretreatment and posttreatment laboratory variables were also compared. RESULTS: A total of 74 subjects (49±6 y, F/M: 36/38) were enrolled in celecoxib group and 76 subjects (49±7 y, F/M: 39/37)in loxoprofen group. Five in celecoxib group and 4 in loxoprofen group were excluded from CE analysis mainly due to incomplete CE. The percentage of subjects with at least 1 posttreatment mucosal break was lower in celecoxib group (10%) than in loxoprofen group (49%) (P<0.0001). A total of 0.3±1.0 posttreatment small intestinal mucosal breaks were detected in the celecoxib group, and 6.8±21.5 in the loxoprofen group (P<0.0001). Posttreatment hemoglobin concentration in loxoprofen group (5.1% reduction) was lower compared with celecoxib group (2.1% reduction) (P=0.006). CONCLUSIONS: In terms of protection of small intestine from NSAIDs toxicity, celecoxib monotherapy was superior to loxoprofen+lansoprazole combination therapy (UMIN: 000007936).

DOI： 10.1097/MCG.0000000000000372

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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：LIPPINCOTT WILLIAMS & WILKINS  

GOALS: The aim is to elucidate the efficacy and safety of double-balloon endoscopy (DBE) for small bowel capsule endoscopy (SBCE) retrieval from small bowel stricture and to follow the outcome of the stricture where the SBCE was entrapped. BACKGROUND: The retention of SBCE is a serious adverse event and most retained capsules are retrieved by surgery. There is still no report analyzing the follow-up of patients with stricture after retrieval of entrapped SBCEs by DBE. METHODS: This study was designed a retrospective cohort study. Subjects were 12 consecutive patients with small bowel stricture where retrieval of entrapped SBCE was attempted using DBE. Success rate of the SBCE retrieval by DBE, surgical rate of the small bowel stricture, adverse events of DBE, and outcomes in the follow-up period were evaluated. RESULTS: Diagnoses were Crohn's disease, nonsteroidal anti-inflammatory drugs-induced enteropathy, ischemic enteritis, and carcinoma in 8, 2, 1, and 1 patients, respectively. SBCE was successfully retrieved in 11 of the 12 patients (92%). No adverse events were encountered in all endoscopic procedures such as retrieval of SBCEs and dilation of the strictures. Nine of the 12 patients (75%) did not undergo surgical treatment for the stricture where SBCE was entrapped through the follow-up period (mean, 1675±847 d). CONCLUSIONS: Retrieval of SBCEs using DBE was safe, had a high success rate, and was useful to evaluate the need for surgery. Seventy-five percent of patients with small bowel stricture where the SBCE was entrapped did not require surgery through approximately 5 years.

DOI： 10.1097/MCG.0000000000000335

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：英語   出版者・発行元：BAISHIDENG PUBLISHING GROUP INC  

Generally, proton-pump inhibitors (PPIs) have great benefit for patients with acid related disease with less frequently occurring side effects. According to a recent report, PPIs provoke dysbiosis of the small intestinal bacterial flora, exacerbating nonsteroidal anti-inflammatory drug-induced small intestinal injury. Several meta-analyses and systematic reviews have reported that patients treated with PPIs, as well as post-gastrectomy patients, have a higher frequency of small intestinal bacterial overgrowth (SIBO) compared to patients who lack the aforementioned conditions. Furthermore, there is insufficient evidence that these conditions induce Clostridium difficile infection. At this time, PPI-induced dysbiosis is considered a type of SIBO. It now seems likely that intestinal bacterial flora influence many diseases, such as inflammatory bowel disease, diabetes mellitus, obesity, non-alcoholic fatty liver disease, and autoimmune diseases. When attempting to control intestinal bacterial flora with probiotics, prebiotics, and fecal microbiota transplantation, etc., the influence of acid suppression therapy, especially PPIs, should not be overlooked.

DOI： 10.3748/wjg.v21.i22.6817

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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：BIOMED CENTRAL LTD  

BACKGROUND: The ErbB family consists of four proteins including (EGFR)/ErbB1, ErbB2, ErbB3, and ErbB4, and plays a crucial role in the promotion of multiple tumorigenic processes. In addition to the traditional pathways of EGFR signaling, EGFR translocates to the nucleus and acts as a transcription factor in the proliferation of cancer cells. Heregulin is known as both an ErbB3 and an ErbB4 ligand. This study aimed to investigate the expression of heregulin and its relevant EGFR family members as well as their phosphorylated forms in human colorectal cancer (CRC) tissues and to determine the relationship between their expression and clinicopathological factors including patient prognosis. METHODS: We analyzed the effects of exogenous heregulin on ErbB2, ErbB3 and ErbB4 phosphorylation in Caco-2, DLD-1, and HCT 116 colon cancer cell lines by western blot analysis. We examined 155 surgical resections from colorectomy patients. Cellular localization of ErbB1-4, their phosphorylated forms and heregulin protein was analyzed in CRC surgical resections by immunohistochemical analysis. Immunohistochemical results were compared with clinicopathological factors and patient prognosis. RESULTS: Phosphorylated ErbB2 (pErbB2) and phosphorylated ErbB3 (pErbB3) were detected in both nuclear and cytosolic fractions of Caco-2 and DLD-1 cells stimulated by exogenous heregulin. Whereas, phosphorylated ErbB4 (pErbB4) was detected only in cytosolic fractions of HCT 116 cells stimulated by exogenous heregulin. Phosphorylated EGFR (pEGFR) immunoreactivity was observed in the cytoplasm and nuclei of cancer cells, whereas the pattern of EGFR staining was membranous and cytoplasmic. Subcellular localization of pErbB2, cytoplasmic, membranous, or nuclear, varied among cases. pErbB3 immunoreactivity was exclusively observed in the nuclei of cancer cells. pErbB4 immunoreactivity was observed in the cell membrane of cancer cells. Statistically, heregulin immunoreactivity correlated with pErbB2 and pErbB4 expression. In multivariate analysis for disease free survival, lymph node status, pErbB3 and pErbB4 expression retained independent prognostic significance. In multivariate analysis for overall survival, lymph node status, pEGFR and pErbB4 retained independent prognostic significance. CONCLUSIONS: ErbB2 and ErbB3 phosphorylated by heregulin localized in the nucleus of CRC cells. Phosphorylated ErbB1-4 and heregulin contribute to poorer patient prognosis in CRC. This heregulin-ErbB family member autocrine loop may be a candidate for targeted treatment of CRC.

DOI： 10.1186/1471-2407-14-863

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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：WILEY-BLACKWELL  

Recently, a report showed that proton-pump inhibitors (PPI) exacerbate non-steroidal anti-inflammatory drug-induced small intestinal injury in the rat. In the present report of two human cases, small intestinal injuries were probably induced and/or exacerbated after PPI treatment. Case 1 was a 30-year-old healthy man in whom no small intestinal mucosal break was detected at baseline capsule endoscopy. After 2 weeks of omeprazole given 20 mg once daily, he was found to have two small intestinal mucosal breaks. Case 2 was a 40-year-old healthy man in whom six small intestinal mucosal breaks were detected at baseline capsule endoscopy. After 2 weeks of omeprazole given 20 mg once daily, 12 small intestinal mucosal breaks were detected. Follow-up capsule endoscopy carried out 3 weeks after stopping omeprazole in case 2 showed seven small intestinal mucosal breaks were detected, showing restitution of the small intestinalmucosal injury. These two cases were obtained from a pilot study evaluating the effect of single administration of PPI on small intestinal mucosa in humans. In the pilot study, six healthy male volunteers were given omeprazole 20 mg for a period of 2 weeks. Small intestinal injury was evaluated before and after PPI treatment using capsule endoscopy. In four subjects other than the two above-mentioned cases, no small intestinal mucosal breaks were found at both baseline and post-treatment capsule endoscopy. Considering the two cases with increased or newly detected small intestinal mucosal breaks, omeprazole may exacerbate/induce small intestinal injury.

DOI： 10.1111/den.12188

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記述言語：日本語   出版者・発行元：The Medical Association of Nippon Medical School  

DOI： 10.1272/manms.10.38

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その他リンク： http://search.jamas.or.jp/link/ui/2014195528

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  

Immunoglobulin (Ig) A vasculitis (IgAV), previously known as Henoch-Schönlein purpura, is a systemic IgA-mediated leukocytoclastic vasculitis that usually affects children. We report the usefulness of video capsule endoscopy in 2 adolescent patients with IgAV having gastrointestinal involvement. Both patient 1, a 15-year-old girl, and patient 2, a 14-year-old boy, presented with purpuric rash and abdominal pain. Video capsule endoscopy showed multiple areas of purpuric erythema throughout the small bowel in both patients and showed multiple ulcers with bleeding in patient 2. Patient 1 responded well to oral prednisolone at a dose of 0.5 mg/kg/day. However, in patient 2, prednisolone at a dose of 0.5 mg/kg/day failed to control the symptoms; therefore, the dose was increased to 1 mg/kg/day to provide relief. Video capsule endoscopy was safe in both cases and produced no side effects. In conclusion, video capsule endoscopy is a useful tool for evaluating small bowel lesions in patients with IgAV and provides valuable information for the treatment of IgAV with gastrointestinal involvement.

DOI： 10.1272/jnms.81.114

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Luminal bacteria, one of the main aggressive factors of nonsteroidal anti-inflammatory drugs (NSAIDs), induce small intestinal mucosal injury. Because most bacteria invading from the mouth are eliminated by the highly acidic gastric environment, the upper small intestine contains relatively low numbers of microorganisms. With decreased peristalsis, decreased acidity, and lower oxidation-reduction potential, the ileum maintains a more diverse microflora and a higher bacterial population. As NSAID-induced small intestinal ulcerations tend to localize in the small intestinal distal part, as viewed by capsule endoscopy, the ulcers are in contact with a large amount of luminal bacteria. Recently, it was reported that proton-pump inhibitors (PPIs) exacerbate NSAID-induced small intestinal injury in rats. The study showed that PPIs impair the ability to disinfect due to the PPI-induced low acidic gastric environment, and this resulted in transubstantiation of intestinal flora which exacerbated NSAID-induced small intestinal injury. If it is true that PPIs exacerbate small intestinal injury, the methods of preventing NSAID-induced gastroduodenal injury to defend PPI-induced small intestinal injury should be reconsidered. Following several studies, there may be a possibility that probiotics and prebiotics are useful treatments for the prevention of NSAID-induced small intestinal injury. A method of determining bacterial flora maintenance including alteration of the environment and the administration of various drugs is required.

DOI： 10.1007/s12328-013-0424-8

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記述言語：日本語   出版者・発行元：(株)先端医学社  

炎症性腸疾患(IBD)関連腫瘍の遺伝子異常、マイクロサテライト不安定性、遺伝子メチル化などに関する多くの報告がある。IBD関連大腸癌の癌化過程では、散発性大腸癌の発癌過程に密接に関与するAPC、K-ras、p53遺伝子異常の頻度やタイミングは異なる。p53免疫染色はその遺伝子自体の変異を反映しており、IBD関連大腸発癌過程の早期からp53過剰発現がみられるため、簡便で有用な早期病変検出法といえる。IBDの非腫瘍粘膜においても、高頻度にp16INK4a、p14ARF遺伝子のメチル化がみられることやIBD関連腫瘍非合併例にくらべ、腫瘍合併例における非腫瘍粘膜のエストロゲンレセプターのメチル化の頻度が高いことも示されており、IBD関連大腸発癌過程の早期病変の発見に役立つ可能性を示唆している。(著者抄録)

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

BACKGROUND: The introduction of capsule endoscopy (CE) has facilitated the detection of mucosal changes in the small bowel, and such mucosal changes have been noted in cirrhotic patients with portal hypertension; these changes are described as portal hypertensive enteropathy. The aim of this study was to assess the effects of transjugular intrahepatic portosystemic shunt (TIPS) on the small bowel mucosal changes detected by CE in cirrhotic patients with portal hypertension. METHODS: TIPS was performed in fifteen cirrhotic patients with portal hypertension. All patients underwent CE before and 2 weeks after TIPS. The small bowel mucosal changes were defined as edema, angiodysplasia-like lesions, red spots, and small bowel varices. Changes in the portosystemic pressure gradient (PSG) and CE findings were evaluated. RESULTS: Before TIPS, small bowel edema was detected in all 15 patients, angiodysplasia-like lesions in 7, and red spots in 14 patients. The PSG decreased significantly, from 21.2 ± 2.6 before TIPS to 8.9 ± 3.3 mmHg (p < 0.001) after the procedure. After TIPS, the small bowel edema was attenuated in 8 of the 15 patients. In two patients with angiodysplasia-like lesions and 4 with red spots, these lesions were attenuated after TIPS. The average score for small bowel edema and the grade of red spots were reduced significantly after TIPS (2.3 ± 0.7-1.8 ± 0.6, p < 0.005 and 1.6 ± 0.9-1.3 ± 0.7, p < 0.05, respectively). Small bowel varices were seen in 4 patients before TIPS and all these varices disappeared after TIPS. CONCLUSIONS: In cirrhotic patients with portal hypertension, small bowel edema, red spots, and small bowel varices were attenuated after TIPS. Portal hypertension may be an important factor in the development of small bowel mucosal changes.

DOI： 10.1007/s00535-012-0660-6

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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：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HINDAWI PUBLISHING CORPORATION  

Unresectable colorectal carcinomas (CRCs) as considered incurable even if the primary tumors and the metastatic ones can undergo resection are correlated with poor prognosis. We evaluated the association between micropapillary pattern at the invasive front and unresectable CRCs. Thirty-four out of 264 (12.9%) CRC patients with stages III and IV were unresectable cases. The patients with unresectable CRCs had significantly worse survival than those with resectable CRCs (P < 0.001). Micropapillary pattern was evident in 12 (4.5%) out of 264 cases. This pattern was observed in 6 of 34 (17.6%) unresectable CRCs and in 6 of 230 (2.6%) resectable cases (P = 0.002). Unresectable CRCs revealed more frequently deeper invasion (odds ratio (OR), 1.175; 95% confidence interval (CI), 1.113-1.241), lymph node metastasis (OR, 2.356; 95% CI, 1.132-4.905), and presence of micropapillary pattern at the invasive front (OR, 8.000; 95% CI, 2.415-26.504) as compared to resectable cases. By multivariable logistic regression analysis, only micropapillary pattern was shown to be an independent predictor of unresectable CRCs (OR, 9.451; 95% CI, 2.468-36.196; P < 0.001). In conclusion, micropapillary pattern at the invasive front is associated with unresectable CRCs, and detection of it could help identify unresectable CRC cases.

DOI： 10.1155/2013/851623

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

BACKGROUND/AIM: Previous studies have reported small intestinal lesions in patients with portal hypertensive disease. However, the etiology of these lesions is not clear, as portal venous pressure was not measured in any of these studies. The aim of this study is to clarify the association between small intestinal lesions and hepatic venous pressure gradient (HVPG), which correlates well with portal venous pressure. METHODS: Thirty-five patients with liver cirrhosis were evaluated by capsule endoscopy for small intestinal lesions. HVPG was measured within 3 days of capsule endoscopy. Blood tests, clinical symptoms, Child-Pugh classification and HVPG were analyzed against small intestinal lesions such as edemas, red spots, angiodysplasia and varices. Lesions were categorized according to their location in the duodenum, jejunum or ileum. Edema was evaluated using a 4-grade capsule endoscopy scoring index. RESULTS: HVPG and edema scores increased with Child-Pugh scores. Red spots and angiodysplasia did not correlate with HVPG. Varices were detected in only 5 patients. The edema score was the factor which most strongly correlated with HVPG by multivariate analysis (p = 0.0008). There was also a strong linear relation between edema scores and HVPG (R = 0.75, p < 0.0001). CONCLUSION: Small intestinal edemas showed the strongest correlation with HVPG among all small intestinal lesions.

DOI： 10.1159/000338180

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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：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CHURCHILL LIVINGSTONE  

BACKGROUND & AIMS: There are no data regarding basal folate levels in patients without colorectal adenoma. This study aimed to determine the minimum serum folate concentration that associates with reduced risk of colorectal adenoma. METHODS: 1510 consecutive patients underwent total colonoscopy for suspected colorectal lesions after barium enema examination. Prior to colonoscopy, history of alcohol consumption was noted and blood serum analyzed for folate and vitamin B12 levels. Polypoid lesions were evaluated histologically. We excluded patients with anemia, history of colonoscopy, overconsumption of alcohol, or malignancies. In all, 458/1510 patients (male/female; 258/200, 40-75 years) were determined eligible. Variables were compared between patients with adenoma and those without adenoma. RESULTS: Serum folate concentration was the variable with the most significant statistical variation between males with adenoma (8.0 ng/ml) and males without adenoma (9.2) (p = 0.001). Serum folate concentrations in females with adenoma did not differ significantly from those in females without adenoma (10.7 versus 10.9). When subjects were stratified into groups according to serum folate, we found no significant difference in the prevalence of adenoma in patients with folate levels greater than 8.0 ng/ml. CONCLUSION: Patients with serum folate concentrations above 8.0 ng/ml had the lowest risk of developing colorectal adenoma.

DOI： 10.1016/j.clnu.2011.04.007

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Recent studies, included using capsule endoscopy and balloon endoscopy, have revealed that nonsteroidal anti-inflammatory drugs (NSAIDs) can cause a variety of abnormalities in the intestine. Several reports show that NSAIDs included acetylsalicylic acid can induce small intestinal injuries with high prevalence in patients taken these drugs. These reports have shown that the preventive effect of proton pump inhibitors (PPIs) does not extend to the small intestine, suggesting that concomitant therapy may be required to prevent small intestinal side effects associated with NSAIDs use. Recently, several randomized controlled trials evaluated the preventive effect of mucoprotective drugs and cyclooxygenase-2 selective inhibitors against traditional NSAIDs-induced small intestinal injury. However, those studies were limited to a small number of subjects and tested short-term NSAIDs treatment. Therefore, further extensive studies are clearly required to ascertain the beneficial effect of these drugs.

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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  

Low-dose acetylsalicylic acid has been widely used. We evaluated small bowel and gastric injuries during acetylsalicylic acid administration using video capsule endoscopy and gastroduodenal endoscopy. We also investigated blood flow using contrast-enhanced ultrasonography. Six healthy volunteers were enrolled in this preliminary study. The subjects were administered 100 mg of enteric-coated aspirin daily for 14 days. Video capsule endoscopy and gastroduodenal endoscopy were simultaneously performed before administration and on days 1, 3, 7 and 14. Contrast-enhanced ultrasonography was performed before administration and on day 2, and 8. Video capsule endoscopy after administration of low-dose acetylsalicylic acid revealed small bowel mucosal damages of petechiae and erythema in all cases, and denuded area in one case. The total number of lesions in the small bowel increased according to duration of low-dose acetylsalicylic acid administration. However, the total number of lesions in the stomach peaked on day 3. Contrast-enhanced ultrasonography showed that the time-intensity curve peak value and Areas under the curves after acetylsalicylic acid administration were reduced. We observed not only gastric mucosal injuries but also small intestinal injuries with short-term low-dose acetylsalicylic acid administration. Acetylsalicylic acid administration also caused a decrease in small intestinal blood flow. Contrast-enhanced ultrasonography is useful for evaluation blood flow in the small bowel mucosa.

DOI： 10.3164/jcbn.10-112

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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：MOSBY-ELSEVIER  

DOI： 10.1016/j.gie.2010.08.033

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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）  

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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  

BACKGROUND: A study reported that rebamipide was effective at reducing short-term nonsteroidal anti-inflammatory drug (NSAID)-induced enteropathy. The purpose of this study was to re-evaluate the effect of the co-administration of rebamipide on small intestinal injuries induced by short-term NSAID treatment. METHODS: Eighty healthy male volunteers were randomly assigned to two study groups: a control group (N = 40), which received NSAID (diclofenac sodium, 75 mg/day) and omeprazole (20 mg/day) treatment along with a placebo; and a rebamipide group, which received NSAID, omeprazole and rebamipide (300 mg/day). Small intestinal injuries (mucosal breaks plus denuded areas) were evaluated by capsule endoscopy before and after 14 days of treatment. RESULTS: A total of 38 control subjects and 34 rebamipide subjects completed the treatment and were evaluated by capsule endoscopy. NSAID therapy increased the mean number of mucosal injuries per subject from a basal level of 0.1 ± 0.3 to 16 ± 71 and 4.2 ± 7.8 in the control and rebamipide groups, respectively, but the difference was not significant. The difference in the percentage of subjects with at least one mucosal injury post-treatment was also not significant (control 63%; rebamipide 47%). Limiting our analysis to subjects with mucosal injuries, rebamipide co-treatment had the tendency to reduce the mean number of mucosal injuries per subject from 25 in the control group to 8.9 in the rebamipide group (multiple comparisons test; p = 0.088, Mann-Whitney U test; p = 0.038). CONCLUSIONS: Rebamipide co-therapy had the potential to reduce the intensity of small intestinal injury induced by 2-week administration of diclofenac.

DOI： 10.1007/s00535-010-0332-3

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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会  

カプセル内視鏡は，レコーダーを装着後に独立したカプセル型の撮影機を嚥下する内視鏡検査であり，通常の内視鏡検査とは全く異なる注意点がある．滞留・誤嚥に加えて，カプセルが外部からコントロールできないため撮影が不十分となる場合のあることを，検査前に患者に伝えておく必要がある．前処置やカプセル内視鏡の脱着法などにコンセンサスの得られた方法はなく，さまざまな試みがなされている段階である．近年のカプセル内視鏡内蔵電池の長時間化により，全小腸観察の成功率が非常に高まる可能性がある．

DOI： 10.11280/gee.52.2738

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

There are no specific symptoms of patients with carcinoma of the small intestine. Therefore, it is difficult to diagnose in the early stage by imaging modalities such as radiological enteroclysis, computed tomography, and classical endoscopy. However, double balloon endoscopy makes it possible to diagnose the carcinoma of the entire small bowel by taking tissue samples for pathological assessment. The characteristic of endoscopic findings is irregular ulcerated tumor with malignant stricture. It is still difficult to find carcinoma of small intestine in patients without symptoms and most cases are advanced when diagnosis is achieved. We should try to diagnose in early stage by combining images modalities, capsule endoscopy and double balloon endoscopy safely and efficiently, resulting in improving the patients' prognosis.

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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：WILEY-BLACKWELL  

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) induce small intestinal mucosal injuries. The concentrations of NSAIDs, bile acids and intestinal flora may differ in the proximal and distal parts of the small intestine. This study aimed to analyse types and distributions of NSAID-induced small intestinal injuries. SUBJECTS AND METHODS: In total 55 healthy male volunteers were examined using baseline capsule endoscopy (CE). Subjects then undertook a 14-day regimen of NSAID medication (diclofenac sodium, 75 mg day(-1)) with proton-pump inhibitors (omeprazole 20 mg day(-1)) as gastroprotection. After 14 days, subjects underwent post-treatment CE and were assessed for three types of small intestinal injuries: denuded areas, erosions and ulcers. The proximal and distal parts of the small intestine were arbitrarily classified according to CE transit time from the duodenal bulb. RESULTS: Baseline CE revealed six mucosal lesions in 6 of 55 subjects (11%), consisting of three denuded areas and three erosions. Post-treatment CE identified 636 lesions in 32 of 53 subjects (60%); including 115 denuded areas in 16 subjects, 498 erosions in 22 subjects and 23 ulcers in 8 subjects. The distribution of small intestinal injuries differed according to type; denuded areas (90%: 103/115) were predominantly located in the proximal part, erosions throughout the small intestine and all ulcers in the distal part. The location of ulcers and denuded areas differed statistically (P < 0.0001). CONCLUSIONS: The impact of short-term NSAID medication on the small intestine differed according to intestinal site, with most denuded areas identified in the proximal part and all ulcers in the distal part.

DOI： 10.1111/j.1365-2362.2010.02290.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Capsule endoscopy and balloon endoscopy, advanced modalities that allow full investigation of the entire small intestine, have revealed that nonsteroidal anti-inflammatory drugs (NSAIDs) can cause a variety of abnormalities in the small intestine. Recently, several reports show that traditional NSAIDs (tNSAIDs) and acetylsalicylic acid (ASA) can induce small intestinal injuries. These reports have shown that the preventive effect of proton pump inhibitors (PPIs) does not extend to the small intestine, suggesting that concomitant therapy may be required to prevent small intestinal side effects associated with tNSAID/ASA use. Recently, several randomized controlled trials used capsule endoscopy to evaluate the preventive effect of mucoprotective drugs against tNSAID/ASA-induced small intestinal injury. These studies show that misoprostol and rebamipide reduce the number and types of tNSAID-induced small intestinal mucosal injuries. However, those studies were limited to a small number of subjects and tested short-term tNSAID/ ASA treatment. Therefore, further extensive studies are clearly required to ascertain the beneficial effect of these drugs.

DOI： 10.3390/ph3041187

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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：WILEY-BLACKWELL PUBLISHING, INC  

Pyogenic granuloma is a lobular capillary hemangioma that occurs mostly on the skin, and occasionally on the mucosal surface of the oral cavity, but very rarely in the gastrointestinal tract. We report the case of a 63-year-old woman who suffered from palpitations, and iron deficiency anemia for 5 years. Esophagogastroduodenoscopy and colonoscopy could not reveal significant bleeding focus. She had not received medical treatment except for oral iron. Capsule endoscopy revealed a bleeding focus in the small intestine. Afterwards, we carried out double balloon endoscopy to treat the lesion. We found a subpedunculated polyp in the small intestine at 100 cm away from ileocecal valve by double balloon endoscopy and resected it endoscopically. The histological features of the polyp were consistent with pyogenic granuloma. Anemia had improved gradually without giving oral iron after polypectomy.

DOI： 10.1111/j.1443-1661.2009.00928.x

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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  

Capsule endoscopy and balloon endoscopy, advanced modalities that now allow for full investigation of the entire small intestine, have revealed that non-steroidal anti-inflammatory drugs (NSAIDs) can cause a variety of abnormalities in the small intestine. Traditional NSAIDs can induce small intestinal injuries in over 50% of patients. Several studies have shown that the preventive effect of proton pump inhibitors does not extend to the small intestine, suggesting that concomitant therapy may be required to prevent small intestinal side effects associated with traditional NSAIDs use. Recently, several randomized controlled trials used capsule endoscopy to evaluate the preventive effect of certain drugs on NSAID-induced small intestinal injuries. These studies show that misoprostol and rebamipide have a preventive effect for NSAID-induced small intestinal mucosal injuries. However, these studies included only a small series of healthy volunteers and tested short-term NSAID treatment. Therefore, further extensive studies are clearly required to ascertain the beneficial effect of these drugs.

DOI： 10.1159/000308361

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記述言語：日本語   出版者・発行元：Japan Gastroenterological Endoscopy Society  

カプセル内視鏡やダブルバルーン内視鏡はともに高い診断能を有する検査法である．小腸内視鏡検査の一番の適応は原因不明の消化管出血であり，その最終診断は腫瘍・潰瘍・血管性病変など多岐に渡る．カプセル内視鏡やダブルバルーン内視鏡の診断能は出血から検査までのタイミングによって大きく異なることが知られており，速やかにカプセル内視鏡やダブルバルーン内視鏡に施行することが大切であり，各種検査方法の特徴を熟知した上で，出血症状や詳細な病歴から症例ごとに最良の検査戦略を組み立てる必要がある．

DOI： 10.11280/gee.51.2853

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その他リンク： http://search.jamas.or.jp/link/ui/2010063747

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  

The aim of this study is to investigate the expression of three prostaglandin E synthase (PGES) isomers in colorectal cancer (CRC) tissue and to evaluate their relationship to clinicopathological factors and patient prognosis. Microsomal PGES (mPGES)-1, mPGES-2, cytosolic PGES (cPGES) and cyclooxygenase (COX)-2 protein expression were analyzed by real-time polymerase chain reaction and Western blot. The localization of each PGES and COX-2 protein was examined by immunohistochemistry in 155 surgical resections and correlated to clinicopathological factors and patient prognosis. mPGES-1 mRNA and protein levels were significantly higher in CRC than in paired normal tissues. mPGES-1 immunoreactivity localized in cancer cells in 43% of cases. mPGES-2 immunoreactivity was significantly more pronounced in cancer cells than in adjacent normal epithelium in 36% of cases. cPGES immunoreactivity was homogeneous in cancer cells and thus determined constitutive. mPGES-1 and mPGES-2 correlated with significantly worse prognosis in stage I-III patients. These results indicate that mPGES-1 and mPGES-2 may each play a role in CRC progression.

DOI： 10.1007/s00428-009-0777-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：MOSBY-ELSEVIER  

BACKGROUND: There is no known preventive agent against nonsteroidal anti-inflammatory drug (NSAID) induced small-intestinal injury. OBJECTIVE: To evaluate by capsule endoscopy whether coadministration of prostaglandin (PG) can prevent small-intestinal damage induced by short-term NSAID treatment. DESIGN: Single-blind, randomized, controlled trial. SETTING: All procedures were performed at Nippon Medical School. SUBJECTS: Thirty-four healthy male volunteers. METHODS: All subjects were randomly assigned to 2 groups: an NSAID-control group, who underwent NSAID (diclofenac sodium, 25 mg 3 times daily) and omeprazole (20 mg once daily) treatment, and an NSAID-PG group, who received PG (misoprostol, 200 microg 3 times daily) in addition to the same NSAID-omeprazole treatment. Eligible subjects, 15 per group, underwent capsule endoscopy before and 14 days after treatment. MAIN OUTCOME MEASUREMENTS: The number of mucosal breaks at capsule endoscopy. RESULTS: NSAID treatment significantly increased the mean (SD) number of mucosal breaks per subject, from a basal level of 0.1 +/- 0.3 up to 2.9 +/- 6.3 lesions in the NSAID-control group (P = .012). In contrast, there was no significant change in the mean number of mucosal breaks before and after PG cotreatment (P = 0.42). Thus, the mean number of posttreatment mucosal breaks per subject was significantly higher in the NSAID-control group than in the NSAID-PG group (P = .028). There was a significant increase in the percentage of subjects in the NSAID-control group, with at least 1 mucosal break after treatment (from 6.7% to 53.3%), whereas there was no change in the incidence of mucosal breaks in the NSAID-PG group, which remained at 13.3%. (P = .002). LIMITATIONS: Single-center, open-label study. CONCLUSIONS: PG cotherapy reduced the incidence of small-intestinal lesions induced by a 2-week administration of diclofenac sodium.

DOI： 10.1016/j.gie.2008.08.017

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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：ELSEVIER SCIENCE INC  

OBJECTIVE: Studies suggest that synbiotic therapy could prove more effective in the treatment of ulcerative colitis (UC) than therapies limited to probiotics or prebiotics. This study compared the effect of each of these therapies in the treatment of UC. METHODS: One hundred twenty outpatients with UC were randomly sorted into three groups of 40 patients each for probiotic, prebiotic, or synbiotic therapy. The probiotic group ingested one daily capsule consisting of Bifidobacterium longum 2 x 10(9) colony-forming units and the prebiotic group ingested daily 8.0-g doses of psyllium. The synbiotic group underwent both treatments. All patients completed Inflammatory Bowel Disease Questionnaires (IBDQs) at the onset of the trial, at the 2-wk midpoint, and at the 4-wk end of the trial. Blood variables were also evaluated in a subset of 32 patients randomly selected from all groups and values were compared with IBDQ scores. RESULTS: Thirty-one patients in the probiotic group, 31 in the prebiotic group, and 32 in the synbiotic group qualified for analyses. The remaining 26 patients had incomplete questionnaires. Total IBDQ scores improved within groups by the end of the trial (probiotics 162 to 169, NS; prebiotics 174 to 182, NS; synbiotics 168 to 176, P = 0.03). Individual scores improved as follows: probiotics, emotional function (P = 0.03); prebiotics, bowel function (P = 0.04); and synbiotics, systemic and social functions (P = 0.008 and P = 0.02). C-reactive protein decreased significantly only with synbiotic therapy (from 0.59 to 0.14 mg/dL, P = 0.04). There were no adverse events. CONCLUSION: Patients with UC on synbiotic therapy experienced greater quality-of-life changes than patients on probiotic or prebiotic treatment. These data suggest that synbiotic therapy may have a synergistic effect in the treatment of UC.

DOI： 10.1016/j.nut.2008.11.017

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

BACKGROUND/AIMS: Heregulin (HRG/NRG) ligation to erbB3/4 promotes their respective heterodimerization with erbB2, and consequent erbB2 tyrosine phosphorylation. Although HRG has been shown to be expressed in a variety of cancer tissues, its expression and role in colon cancer have yet to be clarified. We therefore examined the link between the expression of these erbB receptors, and the relationship between HRG and vascular endothelial growth factor (VEGF) expression in colon cancer. METHODS: We analyzed the effects of HRG on VEGF secretion in 6 colorectal cancer cell lines by enzyme-linked immunosorbent assay, and HRG-induced p85 subunit of phosphatidylinositol 3-kinase (p85 PI-3K), Akt, extracellular signal-regulated kinase 1/2 (ERK1/2), and p38 mitogen-activated protein kinase (p38 MAPK) activation in Caco-2 colon cancer cell lines by Western blot. We also examined HRG and VEGF mRNA expression in 16 colon cancer biopsy samples by real-time PCR. The localization of HRG and VEGF protein expression in colon cancer tissue was detected by immunohistochemistry. RESULTS: Exogenous HRG stimulated VEGF secretion in all cell lines examined, and VEGF mRNA expression in Caco-2 cells. HRG also activated p85 PI-3K, Akt, ERK1/2, and p38 MAPK. VEGF secretion was inhibited by both specific p38 MAPK inhibitor and proteasome inhibitor that inhibit nuclear factor kappa B (NF-kappaB) activation. In colon cancer biopsy samples, HRG mRNA expression correlated with VEGF mRNA expression. HRG immunoreactivity was observed both in cancer cells and in mesenchymal cells in colon cancer tissues. CONCLUSION: These data suggest that HRG might affect colon cancer growth by regulating VEGF secretion via the erbB3 signaling pathway through autocrine and paracrine mechanisms.

DOI： 10.1159/000229775

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記述言語：日本語   出版者・発行元：The Medical Association of Nippon Medical School  

We report on a 70-year-old man with recurrent bloody bowel discharge. We detected angiectasia at the distal ileum at initial capsule endoscopy. The angioectasia was treated with double balloon endoscopy. After treatment, bloody bowel discharge recurred. At a second capsule endoscopy after treatment of the distal ileum with double balloon endoscopy, another angiectasia and a bleeding ulcer were detected on the proximal jejunum. The bleeding ulcer was re-treated with double balloon endoscopy. After re-treatment, bloody bowel discharge again recurred. At a third capsule endoscopy, active bleeding was detected at the proximal jejunum. We were then able to diagnose the angiectasia on the proximal jejunum detected at the second capsule endoscopy and to determine that it was the source of bleeding. The angiectasia was detected and was treated with double balloon endoscopy. After treatment, the bloody bowel discharge has not recurred. We should carefully treat patients with multiple angiectasias, because most angiectasias can be sources of bleeding.<br>

DOI： 10.1272/manms.5.221

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その他リンク： https://jlc.jst.go.jp/DN/JALC/00340357659?from=CiNii

記述言語：日本語   出版者・発行元：Japan Gastroenterological Endoscopy Society Kanto Chapter  

ダブルバルーン内視鏡を用いてPeutz-Jeghers症候群の40mm大の有茎性小腸ポリープ2個を，茎を留置スネアで絞扼して放置した。4日後に絞扼したポリープの脱落を確認した。1年後にカプセル内視鏡を施行し，切除すべきポリープを指摘できなかった。茎を留置スネアで絞扼して放置する方法は組織回収が出来ないが，同時に多数のポリープが処置できるので多発ポリープに対して有効な治療法と考えられる。

DOI： 10.11641/pde.75.2_88

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その他リンク： http://search.jamas.or.jp/link/ui/2010068095

記述言語：日本語   出版者・発行元：The Medical Association of Nippon Medical School  

The capsule endoscope (CE) and the double-balloon endoscope (DBE), were developed to visualize the entire small intestine, have substantially altered diagnostic options in patients with small intestinal diseases. The CE provides clear, natural images of the entire small intestine and allows for the visualization of even minute lesions, such as solitary red spots and minor erosions. However, the major disadvantages of the CE are that it sometimes fails to reach the cecum, can become trapped in the intestine, and does not allow biopsy or treatment. The DBE can reach beyond the ligament of Treitz when inserted orally, and can reach beyond the ileocecal valve when inserted anally; therefore, real-time visualization of the entire small intestine is possible when the oral and anal approaches are combined. The DBE provides sharp endoscopic images, but its main advantage lies in its four-directional angle of operation and special instrument channel that allow both directed biopsies and treatments, such as the resection of polyps and the dilation of strictures. However, the major disadvantages of examination with the DBE when compared with the CE are that it requires sedation, often requires fluoroscopy, and cannot be performed without additional support staff. Therefore, the CE can be used to screen for small intestinal pathologies, and the DBE can be used for the optimal diagnosis and treatment of these diseases. Both the CE and DBE should be established as gold standards in the diagnosis and treatment of small intestinal lesions.<br>

DOI： 10.1272/manms.5.130

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その他リンク： https://jlc.jst.go.jp/DN/JALC/00330853321?from=CiNii

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

BACKGROUND: Double-balloon endoscopy (DBE) is a new method that allows visualization, tissue sampling, and therapeutic intervention of a variety of pathologies throughout the small-intestinal tract. OBJECTIVE: In the present study, we evaluated the diagnostic yield of DBE and its impact on the final diagnosis, treatment, and clinical outcome of patients with obscure GI bleeding (OGIB). DESIGN AND SETTING: A hospital-based cross-sectional, follow-up study. PATIENTS: We studied 108 consecutive patients (66 men and 42 women) referred to our hospital from July 2003 to February 2007 for the evaluation of OGIB: 13 patients with overt-ongoing bleeding, 76 with overt-previous bleeding, and 19 with occult OGIB. MAIN OUTCOME MEASUREMENTS: Diagnostic yield, a final diagnosis, treatment, and clinical outcome were all analyzed in each group. RESULTS: DBE diagnostic rates for patients with overt-ongoing, overt-previous, and occult bleeding were 100.0%, 48.4% and 42.1%, respectively. The difference in diagnostic yields between the overt-ongoing group and the 2 other groups was statistically significant (P < .005). The most common sources of bleeding were ulcers and tumor lesions. Small-intestinal lesions were identified in 52 of 108 patients; of which 36 patients (69.2%) were biopsied and 49 patients (94.2%) received treatment. Eight patients (7.4%) had recurrent bleeding during the mean follow-up period of 28.5 months. Sensitivity, specificity, and positive and negative predictive values of DBE in the diagnoses of small-intestinal lesions in patients with OGIB were 92.7%, 96.4%, 98.1%, and 87.1%, respectively. No serious complications were encountered. CONCLUSIONS: DBE was proven to be a very useful diagnostic tool and had a therapeutic impact in the majority of patients with OGIB. The best candidates for the procedure were patients with overt-ongoing bleeding.

DOI： 10.1016/j.gie.2008.03.1062

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Small intestinal primary adenocarcinomas, carcinoids, gastrointestinal stromal tumors (GISTs) were cleared up inadequately because it was hard to examine for small intestine by modalities in the 20th century. Obscure gastrointestinal bleeding (OGIB) is often caused by these tumors. In future, these tumors will be more diagnosed in patients with OGIB by new modalities such as capsule endoscopy and double balloon endoscopy. We attempt to present these small intestinal malignant tumors using by capsule endoscopy and double balloon endoscopy.

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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：GEORG THIEME VERLAG KG  

Background and study aims: Several studies have shown the value of capsule endoscopy and double balloon endoscopy (DBE) in small-intestinal bleeding. The purpose of this study was to evaluate the impact of capsule endoscopy results on subsequent DBE examination, and the 1-year clinical outcome of this combined approach in patients with obscure gastrointestinal bleeding (OGIB).
Patients and methods: A total of 45 consecutive patients with OGIB underwent capsule endoscopy. Patients with positive capsule endoscopy results underwent DBE for biopsy or therapy, and those with negative results underwent further assessment for possible diagnostic misses on capsule endoscopy. Tumors, ulcerations, and vascular lesions were considered as sources of bleeding. Diagnoses of OGIB lesions and clinical outcome were assessed 1 year after these examinations.
Results: Responsible lesions were found in 22 patients (49%): 19 lesions in 18/45 patients (40%) undergoing capsule endoscopy, and 18/36 patients (50%) undergoing subsequent DBE. In all, 10 tumors, nine vascular lesions, and four ulcerations were found. In two patients, vascular lesions were only later diagnosed by conventional methods (4%). Capsule endoscopy results guided our choice of the proper DBE model for successful therapeutic intervention in five patients. Re-bleeding rates were low during 1-year follow-up of the entire group (mean follow-up, 18.8 months): 5 % in cases with positive diagnoses on capsule endoscopy and/or DBE, and 12 % in negative cases.
Conclusions: A combined approach using capsule endoscopy followed by DBE proves valuable in the diagnosis and treatment of patients with OGIB, leaves a low rate of undiagnosed bleeding sources, and has a good long-term outcome.

DOI： 10.1055/s-2007-967014

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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：BLACKWELL PUBLISHING  

BACKGROUND: Clinical trials of probiotic treatment for Crohn's disease (CD) have yielded conflicting results. This study assessed the clinical usefulness of combined probiotic and prebiotic therapy in the treatment of active CD. METHOD: Ten active CD outpatients without history of operation for CD were enrolled. Their mean (+/-SD) age was 27 +/- 7 years and the main symptoms presented were diarrhea and abdominal pain. Patients' initial therapeutic regimen of aminosalicylates and prednisolone failed to achieve remission. Patients were thus initiated on a synbiotic therapy, consisting of both probiotics (75 billion colony forming units [CFU] daily) and prebiotics (psyllium 9.9 g daily). Probiotics mainly comprised Bifidobacterium and Lactobacillus. Patients were free to adjust their intake of probiotics or prebiotics throughout the trial. Crohn's disease activity index (CDAI), International Organization for the Study of Inflammatory Bowel Disease (IOIBD) score and blood sample variables were evaluated and compared before and after the trial. RESULTS: The duration of the trial was 13.0 +/- 4.5 months. By the end of therapy, each patient had taken a 45 +/- 24 billion CFU daily probiotic dose, with six patients taking an additional 7.9 +/- 3.6 g daily psyllium dose. Seven patients had improved clinical symptoms following combined probiotic and prebiotic therapy. Both CDAI and IOIBD scores were significantly reduced after therapy (255-136, P = 0.009; 3.5-2.1, P = 0.03, respectively). Six patients had a complete response, one had a partial response, and three were non-responders. Two patients were able to discontinue their prednisolone therapy, while four patients decreased their intake. There were no adverse events. CONCLUSION: High-dose probiotic and prebiotic cotherapy can be safely and effectively used for the treatment of active CD.

DOI： 10.1111/j.1440-1746.2006.04535.x

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記述言語：日本語   出版者・発行元：The Medical Association of Nippon Medical School  

DOI： 10.1272/manms.3.164

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その他リンク： http://search.jamas.or.jp/link/ui/2008098346

記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 54-year-old man was admitted to our hospital with the symptoms of palpitation, dyspnea, and tarry stool. Upper gastroduodenal endoscopy revealed submucosal lesions with vascular ectasia in the second part of the duodenum. Dynamic computed tomography (CT) detected a hypervascular lesion in the pancreatic head and the duodenum. Selective angiography showed proliferation of a vascular network and early filling of the portal vein at the early arterial phase. With a diagnosis of pancreatic arteriovenous malformation (AVM), we performed pylorus-preserving pancreaticoduodenectomy. At laparotomy, localized and meandering vessels were seen on the surface of the head of the pancreas. Histological examination showed dilated tortuous vessels accompanied by severed elastic fibers in the vessel media and blood clot formation. The incidence of pancreatic AVM remains extremely low, and recurrent gastrointestinal bleeding is a frequent complication. To prevent recurrent bleeding and progressive portal hypertension, surgery may be the definitive management of symptomatic AVM.

DOI： 10.1272/jnms.73.346

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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：LIPPINCOTT WILLIAMS & WILKINS  

PURPOSE: Elevated expression of cyclooxygenase-2 has been found in colorectal cancer. One of the mechanisms through which cyclooxygenase-2 affects tumorigenesis is through its overexpression, which leads to increased invasiveness of cancer cells. A crucial step in this pathway is thought to be the induction of membrane-type-1 matrix metalloproteinase, which activates matrix metalloproteinase-2. However, to date there have been few clinicopathologic studies concerning cyclooxygenase-2-mediated invasiveness in human colorectal cancer tissues. METHODS: We performed immunohistochemical analysis of the respective antigens on colorectal cancer specimens obtained by surgical resections from 96 patients with colorectal cancer. RESULTS: Cyclooxygenase-2 and membrane-type-1 matrix metalloproteinase expression was positive exclusively in cancer cells in 88 cases (92 percent) and 23 cases (24 percent), respectively. All 23 cases expressing membrane-type-1 matrix metalloproteinase also expressed cyclooxygenase-2. Matrix metalloproteinase-2 expression was positive in cancer cells in 20 cases (21 percent) and stromal cells in 52 cases (54 percent). Expression of matrix metalloproteinase-2 in cancer cells correlated with lymphatic invasion and local recurrence. Statistically, a significant correlation was found between cyclooxygenase-2 and membrane-type-1 matrix metalloproteinase expression, and membrane-type-1 matrix metalloproteinase and matrix metalloproteinase-2 expression in cancer cells. There was no association between cyclooxygenase-2 expression and matrix metalloproteinase-2 expression. However, immunostaining of serial sections revealed that in the majority of cases examined, nearly 100 percent of cancer cells expressing matrix metalloproteinase-2 also coexpressed cyclooxygenase-2. CONCLUSIONS: This study indicates strong association between both cyclooxygenase-2 and membrane-type-1 matrix metalloproteinase expression, and membrane-type-1 matrix metalloproteinase and matrix metalloproteinase-2 in colorectal cancer. These results support our thesis of a direct correlation between cyclooxygenase-2 and membrane-type-1 matrix metalloproteinase expression--with consequent association between cyclooxygenase-2 and matrix metalloproteinase-2 activation, and tumor invasiveness andrecurrence in certain cases of colorectal cancer.

DOI： 10.1007/s10350-006-0588-0

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Background and aims: Cyclooxygenase 2 (COX-2) expression in subepithelial macrophages of colorectal adenoma has been suggested as the first in a series of steps leading to colorectal tumorigenesis. We tested the hypothesis that chemokines released from human colorectal adenoma epithelium might be involved in COX-2 expression in macrophages of the lamina propria. Methods: Endoscopic samples of sporadic colorectal adenomas were tested by enzyme linked immunosorbent assay for chemokines involved in macrophage chemotaxis. Localisation of adenoma macrophage chemoattractant protein 1 (MCP-1) and COX-2 were determined by immunohistochemistry. The effects of MCP-1, in the presence or absence of celecoxib, on COX-2 expression, and prostaglandin (PG) E 2 and vascular endothelial growth factor (VEGF) release, were examined in human macrophages isolated from peripheral blood. Results: MCP-1 levels were markedly higher in adenoma with mild-moderate dysplasia (129.7 (19.9) pg/mg protein) and severe dysplasia (227.9 (35.4) pg/mg protein) than in normal colonic mucosa (55.8 (4.2) pg/mg protein). Other chemokine levels, macrophage inflammatory proteins (MIP)-1α and MIP-1β, and the chemokine regulated on activation of normal T cell expressed and secreted (RANTES) did not vary significantly between adenoma and normal mucosa. MCP-1 levels in both adenoma and normal colonic mucosa increased significantly three hours after tissue cultivation in vitro. MCP-1 immunoreactivity was restricted to the adenoma epithelium, with no reactivity seen in adjacent normal epithelial cells. MCP-1 stimulated COX-2 expression and PGE2 and VEGF release in human macrophages. Celecoxib, a selective COX-2 inhibitor, inhibited MCP-1-induced PGE2 and VEGF release in macrophages. Addition of exogenous PGE2 reversed this inhibitory effect on VEGF release, suggesting that MCP-1 in adenoma epithelial cells might be involved in COX-2 expression and subsequent macrophage activation. Conclusions: MCP-1 in colorectal adenoma epithelial cells might be involved in macrophage migration and COX-2 expression, leading to the subsequent development of colonic adenoma.

DOI： 10.1136/gut.2004.059824

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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：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER TOKYO  

BACKGROUND: Recent reports suggest that Helicobacter pylori infection can potentially increase the risk of colorectal cancer. The purpose of this study was to assess the association between H. pylori infection and the risk of colorectal adenoma and adenocarcinoma, and to evaluate any differences on the basis of sex. METHODS: The subjects were 669 (40- to 80-year-old) patients who underwent both barium enema examination and total colonoscopy, and who were evaluated for H. pylori infection by (13)C-urea breath test, urease test, or histological diagnosis of biopsied gastric specimens. There were 142 H. pylori-negative and 527-positive patients. The odds ratios (ORs) for H. pylori-positive patients with colorectal adenoma and adenocarcinoma, and for tumor patients with either adenoma or adenocarcinoma were calculated. RESULTS: Among the H. pylori-negative patients, there were 52 patients without tumor, 63 with adenoma, 27 with adenocarcinoma, and 90 with tumor. Among the H. pylori-positive patients, there were 136, 264, 127, and 391 patients respectively. Pooling all subjects, those infected with H. pylori had a significantly increased OR for adenoma, adenocarcinoma, or tumor, compared to H. pylori-free patients (OR, 1.60, 1.80, and 1.66, respectively). For female H. pylori-positive subjects, the risk of having adenocarcinoma or tumor was significantly higher than that for their H. pylori-free counterparts, while for male H. pylori-positive and -negative subjects, there was no such significant difference. CONCLUSIONS: The results therefore suggest that, in patients aged 40-80 years, H. pylori infection increased the risk of colorectal adenoma and adenocarcinoma, with significantly higher risks for female patients.

DOI： 10.1007/s00535-005-1649-1

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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：TAYLOR & FRANCIS AS  

OBJECTIVE: Neutrophil activation followed by free radical production is a feature that is common to the various forms of gastric injury. However, the roles of cyclooxygenase (COX)-1 and -2 in neutrophil activation have yet to be clarified in the gastric mucosa. We examined the roles of both COX-1 and COX-2 in neutrophil activation and free radical production in ischemia-reperfusion (IR) injury in the gastric mucosa of mice. MATERIAL AND METHODS: Ischemia was induced by clamping the celiac artery for 30 min, then removing the clamp for 90 min. SC-560, a selective COX-1 inhibitor; NS-398, a selective COX-2 inhibitor; or rebamipide, a mucoprotective agent, was administered to mice 60 min before ischemia. Gastric damage was evaluated histologically and by measuring myeloperoxidase (MPO) activity. Expressions of COX protein and intercellular adhesion molecule (ICAM)-1 were evaluated by Western blot analysis and ELISA, respectively. Effects of these drugs on thiobarbituric acid reactive substances (TBARS) and gastric blood flow were also evaluated. RESULTS: COX-2 expression was induced in gastric mucosa 60 min after reperfusion, whereas COX-1 expression remained unaltered. Localization of COX-1 and ICAM-1 in IR-injured mucosa was observed mainly in endothelial cells, while COX-2 expression was detected in mesenchymal cells such as mononuclear cells, spindle-like cells and endothelial cells. SC-560 significantly decreased gastric blood flow at the reperfusion point and reduced gastric mucosal injury in IR mice. Furthermore, SC-560 pretreatment significantly reduced MPO activity, TBARS levels and ICAM-1 expression. In contrast, NS-398 significantly increased ICAM-1 expression, MPO activity and TBARS levels, and aggravated gastric damage in IR mice. Rebamipide pretreatment reduced both COX-2 expression and IR injury. CONCLUSIONS: In IR mice, COX-2 protects the gastric mucosa by down-regulating ICAM-1 expression, whereas COX-1 is involved in up-regulating reperfusion flow, thereby aggravating the mucosa.

DOI： 10.1080/00365520510015827

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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-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  

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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：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: It has been reported that alcohol intake and folate deficiency are associated with an increased risk of colorectal adenomas and carcinomas. Mean corpuscular volume is increased under these conditions. We have reported that the mean corpuscular volume was higher in patients with adenoma. than without, adenoma in middle-aged men. The aim of this study was to assess the association between mean corpuscular volume and risk of colorectal. adenoma in menopausal women.
Methodology: The subjects were 415 menopausal women who underwent both barium enema examination and total colonoscopy, and their blood samples were analyzed. The subjects were divided into two groups with or without adenoma, and were divided into four groups according to the mean corpuscular volume value. Various, variables were compared among the groups, and the odds ratios of adenoma were calculated.
Results: The mean corpuscular volume was higher in patients with adenoma than without adenoma (P=0.002). As for the mean corpuscular volume value, the odds ratio (95% CI) of patients,with adenoma was 1.00 (referent); (mean corpuscular volume (fl) &lt;90), 1.50 (6.93-2.07); (greater than or equal to90 but &lt;92.5), 1.52 (0.97-2.07); (greater than or equal to92.5 but &lt;95) and 2.87 (2.25-3.45); (greater than or equal to95).
Conclusions: Mean corpuscular volume greater than or equal to95 may be used as an index of the risk for colorectal adenomas in menopausal women.

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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：TAYLOR & FRANCIS AS  

Background: There have been no reports that low serum cholesterol levels increase the risk of colorectal adenoma, although many studies have shown that they do increase the risk of colorectal cancer. Alcohol intake, which is associated with a risk of colorectal adenomas, and serum cholesterol levels are closely related. The purpose of this study was to evaluate the influence of alcohol consumption on the association between serum cholesterol levels and colorectal adenoma. Methods: The subjects were 1,349 male patients who underwent both barium enema examination and, total colonoscopy. They answered a questionnaire regarding their alcohol consumption history, and their blood samples were analysed. The subjects were divided into three groups: those with no tumour (with neither adenoma nor adenocarcinoma), those with adenoma and those with adenocarcinoma. Among the groups, the serum total cholesterol and triglyceride levels were compared in all the patients, in the patients who did not drink daily and in the patients who did. Results: In all the patients, the serum cholesterol and triglyceride levels did not differ between the patients with and those without adenoma. In the daily drinkers, the serum cholesterol and triglyceride levels were significantly lower in patients with adenoma than in those without. Conclusions: Significantly lower levels of serum cholesterol and triglycerides were found in daily drinkers with adenoma than in those without.

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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）   出版者・発行元：BLACKWELL SCIENCE ASIA  

Background and Aims: A relatively large number of patients with multiple myeloma have been reported to develop a secondary malignancy such as cancer of the breast, biliary system or bower.
Methods:A retrospective study was performed in 734 patients with hematologic disease diagnosed at Nippon Medical School Hospital between May 1984 and September 1994 to determine the incidence of colorectal cancer in these patients based on a history review, colonoscopic findings, and surgical or autopsy data.
Results: Of the 734 patients, 14 (1.9%) had colorectal cancer; two of 11 patients (18.2%) had pure red cell aplasia; two of 25 patients (8%) had multiple myeloma; and three of 46 patients (6.5%) had aplastic anemia. Patients with:pure red cell aplasia, multiple myeloma or aplastic anemia had colorectal cancer at a significantly higher rate compared to those with leukemia (P &lt; 0.005, P &lt; 0.02, P &lt; 0.01, respectively).
Conclusions: It is possible that a relatively large number of patients with pure red cell aplasia, multiple myeloma or aplastic anemia will develop a colorectal cancer. (C) 2000 Blackwell Science Asia Pty Ltd.

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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会 関東支部  

A 62-year-old man was admitted to our hospital because of dyspnea. He was proved to have HIV antibody. After admission, a large amount of anal bleeding appeared. Colonoscopy performed on the next day showed a large amount of blood, multiple erosions and ulcers in the entire colon and rectum.<br> The varioliform erosions that were characteristic in amoebic colitis and punched out ulcers were also observed. Biopsy was performed from the ulcer bottom, and its specimen revealed Entamoeba Histolytica (trophozoites) in the necrotic tissue. Soon after the tretment with metronidazole, anal bleeding disappered. On colonoscopy performed one month after the treatment ended, erosions and ulcers improved.<br> Because of the underlying disease and the various endoscopic findings of this case, a differential diagnosis was needed, especially with regard to cytomegarovirus colitis. A further comparative study of endoscopic findings of colitis seen in AIDS patients is needed.

DOI： 10.11641/pdensks.53.0_184

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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：BLACKWELL SCIENCE  

There have been only a few endoscopic studies with respect to lower intestinal lesions of leukaemia and malignant lymphoma, although there have been many autopsy studies of these lesions. The aim of this study was to clarify these lesions using endoscopy. Colonoscopy was performed on 11 of 341 patients with leukaemia and on 32 of 105 patients with malignant lymphoma for frequent diarrhoea, anal bleeding or abnormal findings on barium enema examination, between April 1984 and September 1994. In eight of the 11 patients with leukaemia on whom endoscopy was performed, nine lesions were found; aphthoid ulcers, small ulcers or large tumours due to leukaemic infiltration were found in five, and colorectal adenoma was found in only one patient. Antibiotic-associated haemorrhagic colitis or pseudomembranous colitis was found in one patient each. In 10 of the 32 patients with malignant lymphoma, 11 lesions were found. The following were found in one patient each: large lymphomatous tumours, a large lymphomatous ulcer, multiple small polypoid lesions, multiple lymphomatous polyposis; and colorectal cancer or adenoma in six patients. However, the autopsy findings in patients with both diseases were mostly pseudomembrane formation or ulcers due to fungal and/or bacterial infection. It is concluded that accurate endoscopic diagnosis of lower intestinal lesions in patients with leukaemia or malignant lymphoma is essential for staging and treatment of these diseases and for determining their prognosis. Most lesions in leukaemia are aphthoid and small ulcers are due to leukaemic infiltration or antibiotics; most lesions in malignant lymphoma are elevated lesions such as cancer, adenoma or lymphomatous lesions as determined by endoscopy. This is in contrast to pseudomembrane formation or ulcers due to fungal and/or bacterial infection which are detected at autopsy.

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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会 関東支部  

A 55-year-old male visited our department for further examination with positive fecal occul blood test results in the mass screening for colorectal cancer. He complained of abdominal pain and diarrhea which had started about 2 months before. Small ulcers and erosions were observed in the ascending colon and cecum at colonoscopy. Biopsied specimen at the erosions showed numerous trophozoites in the mucosa. Many Lamblias were observed under a microscope in residual liquid collected in the ascending colon or cecum. Thus, this patient was diagnosed as amoebic colitis complicated with Giardiasis.<br> At colonoscopy performed 3 weeks after Metronidazole therapy (1000mg/day) , erosions and ulcers in the ascending colon and cecum disappeared. This patient was thought to be infected with both parasites by taking contaminated foods because he was not homosexual and had no HIV antibody.

DOI： 10.11641/pdensks.52.0_150

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その他リンク： http://search.jamas.or.jp/link/ui/1999101903

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 VERLAG  

Bile acids are believed to play a role in the etiology of colorectal cancer. To examine the relationship between bile acids and colorectal neoplasia, bile acids in colon residual liquid or fecal material were analyzed in 18 patients with colorectal adenoma, 12 patients with colorectal cancer, and 18 healthy control subjects. High-performance liquid chromatography combined with immobilized 3 alpha-hydroxysteroid dehydrogenase in column form showed a significant elevation in the proportion of deoxycholic acid (P &lt; 0.05), lithocholic acid (P &lt; 0.05), secondary bile acids (deoxycholic acid plus lithocholic acid) (P &lt; 0.02), and the chenodeoxycholic acid-lithocholic acid family (chenodeoxycholic acid plus lithocholic acid) (P &lt; 0.05) in the colon residual liquid or fecal material of the patients with colorectal adenoma compared with proportions in the control subjects. A similar trend was noted in the patients with colorectal cancer compared to the control subjects. These findings suggested that an increase in the proportion of secondary bile acids, in particular, of lithocholic acid, was closely related to the pathogenesis of colorectal neoplasia.

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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：SCANDINAVIAN UNIVERSITY PRESS  

Background: Colorectal adenomas are often detected on mass screening, although detection rates with fecal occult blood tests are low. The relationship between colorectal adenomas and the resulting blood loss was examined indirectly, using serum iron and ferritin levels. Methods: Serum iron and ferritin concentrations were measured in 184 men with colorectal adenomas (greater than or equal to 1 cm in 92; &lt;1 cm in 92) and in 92 healthy male controls. Values in the three groups were compared. In the patients with adenomas greater than or equal to 1 cm, serum iron and ferritin levels were compared on the basis of the site, number, histology, and degree of dysplasia of the adenoma. Results: The mean serum iron level was significantly lower in patients with adenomas greater than or equal to 1 cm than in controls (P&lt;0.05), although this level did not differ significantly between those with adenomas &lt;1 cm and controls. The mean serum ferritin level also was significantly lower in patients with adenomas greater than or equal to 1 cm than in those with adenomas &lt;1 cm and controls (P&lt;0.05, P&lt;0.01, respectively), although this level did not differ between those with adenomas &lt;1 cm and controls. There was no difference in mean serum iron or ferritin levels on the basis of the site, number, histology, or degree of dysplasia of the adenoma. Conclusions: We conclude that decreased serum iron and ferritin levels are related only to adenoma size and that adenomas greater than or equal to 1 cm may bleed steadily, resulting in iron deficiency. However, low dietary intake of iron and fiber may be one of the causes of low serum iron and ferritin.

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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会 関東支部  

症例は73歳男性。主訴は食欲不振と体重減少。消化管X線検査，内視鏡検査で胃から大腸の消化管に多数のポリープ様隆起性病変を認めた。また，表在リンパ節とCT検査で縦隔内，腹腔内，骨盤内のリンパ節腫脹を認めた。腋窩のリンパ節生検ではmalignant lymphoma，diffuse，small cleaved，B cell typeであった。胃，十二指腸，大腸より採取された組織からも同様の結果が得られた。以上の結果よりmultiple lymphomatous polyposisと診断した。化学療法（THP-COP）施行後，表在リンパ節はほぼ消失し，消化管病変では上行結腸からS状結腸ではpolyposisの完全な消失を認めたが，胃，十二指腸，直腸では著明な変化は認められなかった。

DOI： 10.11641/pdensks.48.0_111

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Altered colonic mucosal blood flow (CMBF) is thought to be involved in the onset mechanism of ischemic colitis (IC). This study was designed to clarify the features of CMBF in six patients with IC (average age, 61 yr) and 10 control subjects (44.6yr). In the IC patients, CMBF was measured at both the affected site (ulcer margin and surrounding mucosa) and at a normal appearing site, during the active, healing, or recovery phase, by the laser doppler method. In the control group, CMBF was measured in various segments of the colon. The CMBF around the ulcer site during the active phase was significantly lower than that at the homologous segment in normal controls, while CMBF at normal sites in IC patients did not differ markedly from that of normal controls. CMBF in reddened portions of the ulcer margin in IC patients was significantly higher than that of the surrounding mucosa. A significant increase in CMBF was also observed during PGEi administration as compared to that before administration. This evidence clearly indicates that decreased CMBF is involved in the pathogenic mechanism of IC. The CMBF at sites of active mucosal restoration was somewhat increased. Continuous intravenous administration of PGEi was found to increase CMBF in IC patients. Copyright © 1995, Wiley Blackwell. All rights reserved

DOI： 10.1111/j.1443-1661.1995.tb00168.x

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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 VERLAG  

To clarify the significance of serum iron and ferritin as indicators of iron loss caused by continuous bleeding, and, thus, to determine their value as markers of colorectal cancer, values for the two were compared in male patients with early and advanced colorectal cancer and age-matched male controls. The mean value of serum iron levels in patients with advanced colorectal cancer was significantly decreased compared with values in patients with early colorectal cancer and controls, 50.5 +/- 38.6 mug/dl vs 93.0 +/-32.1 mug/dl and 107.1 +/- 32.9 mug/dl, respectively (p &lt; 0.001). The mean value of serum ferritin levels in patients with early and advanced colorectal cancer was also significantly decreased compared with controls, 80.5 +/- 35.0 ng/ml (p &lt; 0.01) and 48.8 +/- 72.8 ng/ml (p &lt; 0.001), respectively, vs 117.1 +/- 46.8 ng/ml. However, there was no significant difference between mean serum iron levels in patients with early colorectal cancer and controls. Eighteen (78.3%) of the 23 patients with advanced colorectal cancer and 3 (16.7%) of the 18 patients with early colorectal cancer had serum iron levels below 85 mug/dl and serum ferritin levels below 60 ng/ml. Levels of both serum iron and ferritin, without clinically evident anemia, are useful indicators of advanced colorectal cancer.

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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会 関東支部  

A 73-year-old man who complained of bloody stool was pointed out to have two polyps of sigmoid colon and admitted to our hospital for further examination and treatment.<br> On admission, mild anemia (Hb 10.5ｇ/dl) and hypergam maglobulinemia (36.1%) were observed. Serum immunoglobulin G (IgG) value was high (3,872 mg/dl) . In immunological electrophoresis, monoclonal gammopathy of IgG_κ type was observed and Bence-Jones protein in urine was positive. The bone marrow was occupied by atypical plasma cells. After all he was diagnosed multiple myeloma of IgG_κ type.<br> He had two plypes at the sigmoid colon, one polype was polypectomized under colonoscopy and proved to be a cancer in adenoma ; the other polyp was a cancer invading in proper muscle layer and surgically resected. The upper GI series and endoscopic examination revealed a gastric cancer of Borrman 3 type, about 5 cm in size, in the lesser curvature of gastric cardia.<br> We reported a rare case of multiple myeloma complicated with both gastric and sigmoid colon cancers.

DOI： 10.11641/pdensks.45.0_200

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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会 関東支部  

Endoscopic and clinicopathological findings in our consecutive 26 patients (19 males and 7 females, average age : 54.7 y.o.) with colorectal submucosal tumor (SMT) treated by endoscopic polypectomy were compared with those in 186 patients in the Japanese literature. In our series, endoscopic ultrasonography (EUS) was carried out as far as possible to evaluate the size, gross appearance, location in the layer structure and ultrasonic characteristics of the tumors. Endoscopic polypectomy was carried out only when the snare-wire loop was tightened within a few mm in diameter.<br> The final diagnosis of the 26 cases were 12 lipomas, 7 carcinoids, 3 leiomyomas, 2 lymphangiomas, one hemangioma and one mixed tumor. Complication of transient lower intestinal bleeding was observed after polypectomy only in one case of lipoma. Correct preoperative diagnosis was not obtained from 5 patients, and 3 of whom were not carried out of EUS. The average size of SMTs resected were 10.1 mm in our series and from 7.3 to 18.9 mm in 186 in the literature. The semipedunculated or pedunculated appearance of SMTs were seen in 54% in our series and 69% in the cases in literature.<br> In conclusion, endoscopic polypectomy can be indicated to colorectal SMTs in the following conditions ; 1) the benign SMT less than 20 mm in diameter showing pedunculated of semipedunculated appearance, and 2) carcinoid tumor less than 10 mm in diameter without any metastasis.

DOI： 10.11641/pdensks.45.0_166

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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会 関東支部  

センナ葉であるCassia angustifolia Vahl（生薬チンネベリーセンナ）とCassia acutifolia Delile（生薬アレキサンドリアセンナ）からなる漢方薬番瀉葉（有効成分はsennoside A，B）による，大腸内視鏡検査前処置法の臨床的有用性について検討した。対象は1992年4月から同年11月の間に，Brown変法による前処置法で注腸造影検査を行い，大腸ポリープと診断した25例である。同一症例に食事制限のない番瀉葉による前処置法で大腸内視鏡検査を行い，入院後，経口腸管洗浄液による前処置法で内視鏡的ポリペクトミーを行った。食事制限の有無，下剤あるいは洗浄液の飲みやすさ，腹痛などの副作用を考慮した時，3つの前処置法のうち番瀉葉を好むものは15例（60％）おり，最も好評であった。腸管洗浄度については，経口腸管洗浄液を用いた前処置法では全例問題がなかったが，番瀉葉を用いた前処置法では不良例が3例（12％）に認められた。結局，番瀉葉による大腸内視鏡検査前処置法は，腸管洗浄効果では経口腸管洗浄液にやや劣るものの，患者には好評であり，臨床症状，血液検査における副作用もほとんどなく，安価であることより，今後，被検者の便通状態を考慮して，番瀉葉および水分摂取量を加減すれば，大腸検査前処置法として臨床的に有用になるものと考えられた。

DOI： 10.11641/pdensks.42.0_104

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その他リンク： http://search.jamas.or.jp/link/ui/1994081489

記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会 関東支部  

症例は26歳男性。25歳時に急性虫垂炎の診断で虫垂切除術を施行された。1992年4月，大量下血とともにショックに陥ったため，当科に入院となった。入院時バイタルサインは正常。高度の貧血所見を認めたが，他の異常所見を認めなかった。大腸内視鏡検査では，盲腸に拍動性出血を伴う絨毛状の隆起性病変を認めたため，電気凝固により止血した。2回目の内視鏡検査時にポリペクトミーを行ったが，このとき病変起始部から絹糸が出現した。病変部の病理組織像はリンパ球，形質細胞の浸潤を中心とした炎症性変化が主体で，異型性は認められなかった。別の部位に出血源が存在する可能性も考えられたため，血管造影，腹部CTスキャンを行ったが，空腸に動静脈吻合が認められるのみで，出血源となりうる病変を指摘しえなかった。以上より虫垂切除術施行後に盲腸に絹糸を核とした隆起性病変を形成し，持続的出血をきたしたと診断した。

DOI： 10.11641/pdensks.42.0_259

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その他リンク： http://search.jamas.or.jp/link/ui/1994077197

記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会 関東支部  

症例は66歳女性。右下腹部痛，持続する微熱を主訴として当科を受診した。注腸造影検査で回盲部結核および盲腸の小隆起性病変を指摘され，精査加療目的で入院した。大腸内視鏡検査では回腸末端部の潰瘍と狭窄，回盲弁の変形，上行結腸から盲腸にかけて小潰瘍が認められた。盲腸には約1cm大の粘膜下腫瘍様病変があり，内視鏡的ポリペクトミーを行った。病理組織学的所見では，粘膜下層にLanghans巨細胞および乾酪壊死が存在し，腸結核による粘膜下腫瘍様病変と診断した。腸結核病変部に炎症性ポリープが認められることはあるが，粘膜下腫瘍様病変が存在し，その内視鏡的ポリペクトミーにより腸結核の確定診断ができた例はまれと考え報告した。

DOI： 10.11641/pdensks.43.0_231

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その他リンク： http://search.jamas.or.jp/link/ui/1994162627

記述言語：日本語  

J-GLOBAL

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記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

Colonoscopy was performed on acute stage within 72 hours from onset in 48 patients with antibiotic-associated hemorrhagic colitis (AAHC). From our observations we have developed a new endoscopic classification of AAHC and investigated the incidence of each finding in further detail. We have classified in principle the endoscopic findings of the 48 subjects into two groups: major and minor ones respectively. Category of major findings were: 1) diffuse mucosal hemorrhage (100%); 2) spotty mucosal hemorrhage (100%), and 3) linear mucosal hemorrhage (22.9%) w, hile minor findings were: 1) irregular ulcers in 10.4%; 2) aphthoid ulcers in 6.3%, a nd 3) linear erosions or ulcers in 4%. Minor findings were ulcers or erosions present over the hemorrhagic mucosa associated with the moderate degree of inflammation. A histopathologic study of colon biopsy specimens from 24 patients with AAHC showed hemorrhage and inflammatory cell infiltration in the lamina propria mucosae varing from mild to moderate in extent. It was concluded that AAHC was a colonic mucosal hemorrhagic disease caused by the destruction of mucosal vessels from unknown causes and in this disease mild to moderate inflammation was partially followed by ulceration over the edematous and hemorrhagic mucosa of the colon.

DOI： 10.1272/jnms1923.59.450

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記述言語：日本語  

CiNii Research

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その他リンク： https://search.jamas.or.jp/link/ui/2019219004

J-GLOBAL

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記述言語：日本語   出版者・発行元：(株)東京医学社  

社会の高齢化に伴い、抗血栓薬服用者の大腸憩室出血は増加している。消化管出血時における抗血栓薬の休薬や再開などの服薬マネジメントについて各国・各学会からガイドラインが策定されているが、これらはエビデンスが乏しく世界標準として一致した推奨はないのが現状である。憩室出血時、抗血栓薬の服薬管理は関連医師間で連携をとり、血栓塞栓リスクと出血リスクを勘案して個別に検討することが重要である。ワルファリンは一時的に休薬すべきとするガイドラインと、休薬は関連医師間で血栓塞栓と出血リスクを検討し決定すべきというガイドラインが存在する。アスピリンは、(1)一次予防で内服している患者、(2)重篤な(生命にかかわる)出血患者は専門医と相談のうえで中止することが望ましく、(3)血栓塞栓症の二次予防、(4)ステント留置後30日以内、(5)急性冠症候群90日以内、のケースでは内服継続が推奨される。なお、休薬後の再開までの日数は、いずれの抗血栓薬も定まった見解はないが、止血確認後の速やかな再開が推奨されることは共通している。急性下部消化管出血で大腸憩室出血を疑った場合は適正な補液・輸血を行ってバイタルサインを安定させ、腸管洗浄剤を用いた大腸内視鏡を24時間以内に行う。内視鏡的止血術にはクリップ法、局注法、凝固法などがあるが、憩室結紮術の有用性が報告されている。(著者抄録)

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記述言語：日本語   出版者・発行元：(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)東京医学社  

本邦において大腸憩室保有率は増加傾向にある。本邦の50歳未満の大腸憩室保有者では、75%近くの憩室が右側結腸に認められ、加齢とともに左側結腸憩室の割合が増加する。欧米では多くの憩室はS状結腸にあり、人種差が認められる。この傾向は憩室炎でも同じである。憩室炎の予後は左側結腸で悪い傾向があり、喫煙と肥満は可能性の高い予後不良因子である。大腸癌と憩室炎の関連についてはコンセンサスが得られていないが、CTなどで診断した大腸憩室炎患者については、大腸癌の鑑別がすすめられる。大腸憩室には人種差、遺伝性が認められ、欧米の報告を直ちに日本人に適用することは危険である。また、パブリケーションバイアスの入りやすいこの疫学分野での解釈には注意が必要である。ガイドラインは、できるだけコンセンサスの得られている内容、もしくはインフォームド・コンセントに有用な内容を心がけて作成した。(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  

大腸憩室出血に対する内視鏡的止血術の適応となる所見は、(1)活動性出血(active bleeding)、(2)非出血性の露出血管(non-bleeding visible vessel)、(3)付着凝血塊(adherent clot)である。これらは、最近出血した徴候(SRH)と定義されている。SRHを示す患者に止血術の介入をしないと30日以内の早期再出血率は53〜66%と高率であること、止血術の介入によって早期再出血率は低下すること、が報告されている。このため、SRHを示す大腸憩室は止血術の治療対象である。SRHを同定することによって、エピネフリン局注法、凝固法、クリップ法、結紮法などによる内視鏡的治療が可能となり、輸血量や入院期間、再出血率を低下させる。SRHの所見を得るためには検査の実施方法に留意が必要で、腸管洗浄剤による前処置、出血後24時間以内の大腸内視鏡、術者が内視鏡専門医であること、先端フードの装着、ウォータージェットスコープの使用、によって良好な結果が得られる。(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  

大腸憩室出血に対する内視鏡的止血術の適応となる所見は、(1)活動性出血(active bleeding)、(2)非出血性の露出血管(non-bleeding visible vessel)、(3)付着凝血塊(adherent clot)である。これらは、最近出血した徴候(SRH)と定義されている。SRHを示す患者に止血術の介入をしないと30日以内の早期再出血率は53〜66%と高率であること、止血術の介入によって早期再出血率は低下すること、が報告されている。このため、SRHを示す大腸憩室は止血術の治療対象である。SRHを同定することによって、エピネフリン局注法、凝固法、クリップ法、結紮法などによる内視鏡的治療が可能となり、輸血量や入院期間、再出血率を低下させる。SRHの所見を得るためには検査の実施方法に留意が必要で、腸管洗浄剤による前処置、出血後24時間以内の大腸内視鏡、術者が内視鏡専門医であること、先端フードの装着、ウォータージェットスコープの使用、によって良好な結果が得られる。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞消化管出血では,顕出血を伴わないときも常に小腸上皮性腫瘍を疑う必要がある.特に小腸癌は臨床症状を契機に精査されるとき,病変の検出は容易であり,速やかに診断し適切な治療へ導く.腹部-骨盤部X線造影CT検査で所見がないとき,カプセル内視鏡による精査は有用である.今日,小腸癌に対する補助化学療法の有用性を検証する動きが加速している.検査方法は進歩しているが,診断契機は臨床症状の出現であることは以前と変わりがない.そのため,診断時には既に進行していることが多く,早期診断が課題である.また,本邦の罹患率や予後などの疫学データの集積も,診断や治療の進歩を検証するために必要であり,今後の課題である.

DOI： 10.11477/mf.1403201389

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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：(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  

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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)日本薬剤疫学会  

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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：(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：(株)東京医学社  

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記述言語：日本語   出版者・発行元：日本膵臓学会  

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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  

CiNii Research

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その他リンク： https://search.jamas.or.jp/link/ui/2017203923

J-GLOBAL

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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：科学評論社  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2016253616

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)日本メディカルセンター  

小腸憩室はメッケル憩室を除くと非常にまれであり,多くは固有筋層をもたない後天性憩室であり,腸間膜付着側に存在する.回腸よりも空腸に多く,好発年齢は高齢者である.無症状のまま経過することが多いが,出血,憩室炎,穿孔,腹膜炎,腸閉塞などの非特異的な腹部症状を引き起こすことがある.検査は症状に応じて小腸造影,CT,血管造影,カプセル内視鏡,バルーン内視鏡などを適切に選択あるいは組み合わせることが重要である.出血に対してはバルーン内視鏡による内視鏡的止血術や血管造影による塞栓術で手術を回避することも可能である.また憩室炎には抗菌薬投与による保存的治療が選択されるが,穿孔による腹膜炎や腸閉塞などは外科的治療の適応である.(著者抄録)

DOI： 10.19020/J01937.2016223465

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：WILEY-BLACKWELL  

Web of Science

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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  

虚血性小腸炎は腸管の血流不全に伴う組織障害をきたす疾患で,特発性と続発性に分類される.虚血性大腸炎と異なりまれな疾患であるが,小腸内視鏡検査の普及により診断契機が増えつつある.一過性型,狭窄型,壊死型に分類され,狭窄型の頻度が高く,治療はこれまで外科手術が中心であったが,近年,内視鏡による拡張術が試みられるようになっている.(著者抄録)

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記述言語：日本語   出版者・発行元：(NPO)日本消化吸収学会  

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記述言語：日本語   出版者・発行元：(NPO)日本消化吸収学会  

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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：医学書院  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2015000615

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)医学書院  

本邦において,原因不明消化管出血に対してカプセル内視鏡を施行した場合,およそ30%の対象に潰瘍性病変が指摘される.NSAIDsを服用している場合においてはNSAIDs起因性と診断されることが多いが,正確な診断は簡単ではない.さらに,健常者においても10%程度は無症候性の小腸潰瘍性病変を有しており,原因疾患の診断は困難を極めている.近年,腸内細菌叢が小腸潰瘍性病変に深く関与している可能性が指摘されており,今後の解明が望まれている.(著者抄録)

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記述言語：日本語   出版者・発行元：診断と治療社  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2014312057

記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会 関東支部  

A 76-year-old man was admitted to our hospital with dyspnea on exertion, diarrhea, and anemia. Abdominal ultrasonography and computed tomography showed a tumor in the abdominal cavity. Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) revealed an elevated mass with an ulcer in the ileum. Histopathological examination showed a spindle-cell tumor, and the spindle cells were immunopositive for c-kit and CD34. Thus, a definitive diagnosis of gastrointestinal stromal tumor (GIST) was made before surgery. After the diagnosis was confirmed by both CE and DBE, single-incision laparoscopic surgery with partial resection of the segment of the small intestine with tumor was performed via a single 2.5-cm umbilical incision. The postoperative course was uneventful. CE and DBE may be useful diagnostic tools in patients with diseases of the small intestine.

DOI： 10.11641/pde.84.1_134

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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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：医学出版  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2014260759

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：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：SPANDIDOS PUBL LTD  

Web of Science

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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：(有)科学評論社  

ダブルバルーン内視鏡(DBE)を施行した小腸癌16例を対象として、症状、腹部CT・カプセル内視鏡検査における所見陽性率、内視鏡所見などを検討した。その結果、症状は嘔吐50%、腹痛50%、出血症状50%であった。DBE前に腹部CT検査は全例で施行され、うち13例(81%)は病変を指摘できた。残る3例は腹部CTで病変を指摘できなかったが、いずれもカプセル内視鏡で病変が指摘された。また、全例でDBE時に生検が施行され、13例(81%)で組織学的診断が可能であった。平均観察期間24.1ヵ月における生存期間中央値は29.3ヵ月であった。

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2014156505

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)東京医学社  

門脈圧亢進症患者の小腸・大腸には、血管拡張性病変、静脈瘤、浮腫などの病変が知られている。しかし、門脈圧亢進症患者の多くは、同時に深刻な肝障害を伴っており、それらの腸病変が門脈圧と直接相関しているとは限らない。門脈圧と、小腸病変の相関を検討したところ、浮腫と門脈圧の相関は明らかであったが、孤立性の血管拡張性病変(angioectasia)との相関は明らかではなかった。このように門脈圧亢進症性腸症の解明には、門脈圧との相関を調べると同時に、門脈圧亢進をきたす原疾患との関連を顧慮しなければならない。この報告で主要な内視鏡像を紹介するが、この分野は用語の統一も十分ではなく、論文報告もここ数年以内が大半であり、これからの解明の待たれる分野である。(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  

バルーン内視鏡によって,小腸異物を除去することも可能となった.実際の症例では,重篤な症状の有無,異物の種類・数,通過障害の有無を,詳細な病歴聴取や画像診断によって速やかに判断することが大切である.嚥下可能な異物の80〜90%は,自然排出が期待できるため,十分な経過観察下で自然排泄を待つこともある.一方,鋭利で腸壁を貫く可能性のあるものや毒性を生じるものは,速やかに除去を行う.(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：(一社)日本癌治療学会  

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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：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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記述言語：日本語   出版者・発行元：(有)科学評論社  

2003年6月から原因不明消化管出血に対してダブルバルーン内視鏡(DBE)を施行した215例(男性136例。女性79例、年齢19〜90歳、平均年齢61.8±15.3歳)中、DBEで最終診断可能であった111例(男性71例、女性40例、平均年齢62.7±16.0歳)の出血症状パターン、最終診断について検討した。その結果、1)潜在性出血での診断は腫瘍性病変7例(うちGISTが2例)、潰瘍・炎症性病変7例(うちクローン病5例)、血管性病変4例(うち血管拡張症3例)であった。2)顕出血での診断は潰瘍・炎症性病変28例、血管性病変26例、腫瘍性病変24例、憩室性疾患6例、小腸外病変9例であり、潰瘍・炎症性病変ではNSAIDs起因性腸炎11例、クローン病4例、原因不明潰瘍3例であった。また、血管性病変ではDieulafoy&#039;s lesionが14例、血管拡張症が9例、動静脈奇形が3例で、腫瘍性病変ではGISTが10例、癌が3例、悪性リンパ腫3例であった。以上より、顕出血の継続している状況(overt ongoing出血)では診断率が高く治療も行えるDBEが第一選択として望ましく、顕出血が停止している状態(overt previous出血)では他の放射線科学的な検索も出血源同定に有用である可能性が示唆された。

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2013325959

記述言語：日本語   出版者・発行元：(株)医学書院  

カプセル内視鏡(CE)の主要な適応に原因不明消化管出血(OGIB)がある.CEは,欧米で最もOGIBの原因疾患とされているangioectasiaや小潰瘍性病変などの小病変の検出に優れ,これらの小病変の検出に関してバルーン内視鏡(BE)や小腸造影検査などより診断率が優れている.したがって,CEでこれらの小病変を検出し,BEなどで治療する方針が有用である.粗大病変に関しては,CEでは全体像がとらえにくく,BEや小腸造影検査が有用である.近年では,CT・MRIなどを用いたバーチャル内視鏡の進歩が著しく,全体像の診断に対する第1選択検査に置き換わっていく可能性がある.(著者抄録)

DOI： 10.11477/mf.1403113770

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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：科学評論社  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2013183826

記述言語：日本語   出版者・発行元：東京医学社  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2013198865

記述言語：日本語   出版者・発行元：(公社)日本皮膚科学会  

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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)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：医歯薬出版  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2013045664

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)日本大腸肛門病学会  

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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：(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)新興医学出版社  

＜ポイント＞●小腸内視鏡が一般化し、多彩な腫瘍性疾患が明らかとなっている。●症例ごとに、内視鏡以外の画像診断も組み合わせた効率的な診断戦略が必要である。●小腸腫瘍のわが国での疫学データや、疾患の高危険群といった臨床情報が不足しており今後の課題である。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)東京医学社  

小腸出血は小腸内視鏡検査の適応として最も多く、その診断にバルーン内視鏡は非常に有用である。消化管出血では、小腸出血を疑う前から詳細な上部消化管内視鏡や大腸内視鏡を行う。特に、十二指腸潰瘍や大腸憩室出血を正確に除外する。原因不明の消化管出血と判断されたら、臨床情報を踏まえ、速やかに症例に応じた診断戦略を立てることが正診につながるものと思われる。出血源を認められなかったときは、再出血直後にバルーン内視鏡を行い診断率向上に努めることが大切である。(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-関東支部  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

Web of Science

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記述言語：日本語   出版者・発行元：南江堂  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2012181590

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  

NSAID腸炎の特に小腸内視鏡像を提示し、鑑別診断の要点を述べた。NSAID腸炎の潰瘍は回腸に多く、円形〜類円形潰瘍、輪状潰瘍と治癒過程に認められる膜様狭窄、稀ながら縦走潰瘍も認められる。Crohn病の特徴の一つに、病変の局在における腸間膜との位置関係があげられる。腸間膜付着側に病変の多いCrohn病に対し、NSAID腸炎の病変には一定の傾向は認められない。NSAID腸炎の特徴として、原因薬剤の休薬で速やかに治癒する傾向がある。好発年齢や服薬歴などの病歴からも鑑別に重要な情報が得られ、内視鏡的特徴の理解とともに、詳細な臨床情報のもと内視鏡検査を行うことで、Crohn病と類似する所見や分類困難な軽微な所見も鑑別することが可能である。(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  

非ステロイド性抗炎消薬(NSAIDs)は,小腸に多彩な病変を高頻度に起こすことが明らかになった.通常型NSAIDsを2週間服用すると50%を超える服用者に小腸粘膜欠損が現れる.NSAIDs小腸粘膜傷害の診断を,内視鏡所見で行うことは困難だが,小腸口側でみられる絨毛欠損は特徴的な所見である可能性が高い.診断は,NSAIDsの中止で治癒を確認することが基本である.NSAIDs起因性小腸粘膜傷害に対する予防薬・治療薬の候補を探すため複数の試験が行われた.今後は見込みのある薬に対して,大規模な臨床試験が望まれる.(著者抄録)

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記述言語：日本語   出版者・発行元：(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：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：WILEY-BLACKWELL  

Web of Science

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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  

小腸内視鏡の進歩は、アスピリンが胃・十二指腸のみならず小腸に多彩な病変を起こすことを明らかにした。健常人ボランティアを対象に行われた試験によって、アスピリン腸溶錠の服用により上部小腸から潰瘍性病変が起こることが明らかとなった。腸溶錠が上部小腸で溶解するためではないかと考えられている。従来、アスピリン緩衝剤は小腸に病変を引き起こさないと考えられていたが、アスピリン緩衝剤による小腸潰瘍も報告されるようになってきている。まだ潰瘍の特徴を十分に示すことができるほど知見は多くはなく、今後の解明が望まれる。(著者抄録)

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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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  

小腸の悪性リンパ腫の診断・治療について概説した.小腸悪性リンパ腫はさまざまな肉眼形態を呈し,組織型も多種に及ぶ.カプセル内視鏡の普及は小腸悪性リンパ腫の発見契機を増すであろうし,それにより組織診断の必要性からバルーン内視鏡の適応も今後ますます増えるものと予想される.肉眼形態から類推される悪性リンパ腫に対して,分子生物学的手法を含めた精密な組織診断と,詳細な全身検索による病期診断が,適切な治療のために不可欠である.(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)医学書院  

小腸内視鏡の進歩は,非ステロイド性抗炎症薬(NSAID)により,胃のみならず小腸に多彩な病変が高頻度に起こることを明らかにした.特に通常型NSAIDでは2週間で50%を超える服用者に小腸粘膜障害が現れる.NSAID起因性小腸粘膜傷害には粘膜障害と絨毛欠損という異なる2種類の形態があり,小腸粘膜傷害の起因には複数の因子が関与している.NSAID起因性胃粘膜傷害に対して予防法・治療法が確立したため,NSAID服用者の下部消化管傷害に対する対応の確立が急務となっている.本邦を中心として,NSAID起因性小腸粘膜傷害に対する予防薬・治療薬の候補を探すため二重盲検無作為化比較試験を含む複数の試験が小規模ながら行われた.今後は見込みのある薬に対して,より大規模な臨床試験が望まれる.(著者抄録)

DOI： 10.11477/mf.1403102123

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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：(一社)日本内科学会  

DOI： 10.2169/naika.100.50

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記述言語：日本語   出版者・発行元：(社)日本大腸検査学会  

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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：(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  

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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)癌と化学療法社  

小腸癌は多岐にわたる症状を有するが特異的な症状に乏しい。また従来の内視鏡検査では深部小腸への挿入が難しく、X線検査による画像診断に依存していたため、早期発見や術前診断は困難であった。しかしダブルバルーン内視鏡の登場により、全小腸の観察や病理診断が可能となった。内視鏡所見の特徴は、不整な腫瘤や潰瘍を形成し、管腔が狭小化することである。現状では症状がなければ診断が困難であり、診断時には病期が進行していることも多い。予後の改善には早期発見が必須であり、従来のX線検査にカプセル内視鏡やダブルバルーン内視鏡を組み合わせた積極的な小腸検査が必要である。(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)日本メディカルセンター  

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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)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：(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)日本メディカルセンター  

近年,ダブルバルーン内視鏡,カプセル内視鏡の発明により,従来のmodalityと併せて全消化管の観察が可能となり,暗黒大陸といわれてきた小腸領域において日々新しい発見が報告され,これまで原因不明とされてきた消化器症状の究明と治療の幅が広がってきている.小腸に病変を有する疾患は意外に多いが,その病態の詳細が不明なものが少なくない.Schonlein-Henoch紫斑病(HSP)もその一つである.同疾患は約8割に消化器病変を合併し,とくに小腸は好発部位といわれているが,十二指腸,終末回腸以外に小腸病変を内視鏡的に確認しえた報告はまだ少なく,本稿ではこれまでの報告例と併せてHSPの小腸病変を中心に概説する.(著者抄録)

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記述言語：日本語   出版者・発行元：(株)ヴァンメディカル  

カプセル内視鏡により、アスピリンを含む非ステロイド性抗炎症剤(NSAID)を常用する患者の60%以上に小腸粘膜傷害が生じていることがわかった。また、最近の研究で通常型NSAIDを2週間服用しただけで潰瘍性病変を含む小腸粘膜傷害が60%近い服用者に生じることが明らかとなった。NSAID/アスピリン起因性消化管傷害にはCOX-1阻害によるプロスタグランディン(PG)の産生低下が重要で、PGを同時投与することで小腸においても粘膜傷害を軽減できる可能性が高く、本邦からカプセル内視鏡を用いた検討が報告された。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

カプセル内視鏡によりNSAIDs起因性小腸粘膜傷害の実態が明らかになりつつある.アスピリンを含むNSAIDsの常用患者の70%以上に,また通常型NSAIDsの2週間の内服で60%近い服用者に小腸の粘膜傷害が認められた.選択的COX-2阻害薬は短期的には小腸粘膜傷害の発生を軽減させるが,長期的には通常型NSAIDsと粘膜傷害の頻度に差がないという報告もあり,NSAIDs起因性小腸粘膜傷害の治療・予防薬が望まれる.近年,本邦でミソプロストールやレバミピドを用いてNSAIDs起因性小腸粘膜傷害の抑制効果を調べた研究が行われ有望な結果が得られた.今後,他の薬剤を含め投与法,投与量などの検討が望まれる.(著者抄録)

DOI： 10.11477/mf.1403101872

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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-関東支部  

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記述言語：日本語   出版者・発行元：大道学館出版部  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2010053750

記述言語：日本語   出版者・発行元：(有)科学評論社  

著者らが大腸内視鏡検査を行った458例を対象に血清葉酸濃度と大腸腺腫の関係を調べ、大腸腺腫発生を有効に減少させる血清葉酸濃度の設定を試みた。その結果、1)男性・女性ともに血清葉酸濃度で層別化して頻度を計算したところ、血清葉酸濃度8.0ng/ml未満になると濃度減少に従って大腸腺腫の頻度は増加し、血清葉酸濃度6.0ng/ml未満では8.0ng/ml以上に対して大腸腺腫の頻度は男性で約1.4倍、女性で約1.3倍であった。2)血清葉酸濃度8.0ng/mlで全例を男女別に2群に分けてオッズ比を求めたところ、血清葉酸濃度8.0ng/ml未満に対して8.0ng/ml以上のオッズ比は男性で0.49(95%信頼区間0.32〜0.66)、女性で0.77(0.50〜1.05)となった。以上、これらのことからも、血清葉酸濃度8.0ng/ml未満の症例に対して葉酸の補充を行うことが、大腸腺腫発生の頻度を減少させる目的において有用であると考えられた。

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記述言語：英語   掲載種別：速報，短報，研究ノート等（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

DOI： 10.1016/j.gie.2009.03.013

Web of Science

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記述言語：日本語   出版者・発行元：永井書店  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2009334581

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)日本メディカルセンター  

カプセル内視鏡によりNSAIDs起因性小腸粘膜傷害の実体が明らかになってきた.アスピリンを含むNSAIDsを常用する患者の60%以上に,また通常型NSAIDsを2週間服用しただけで60%近い服用者に,潰瘍性病変を含む小腸粘膜傷害が認められた.COX-2選択的阻害薬は短期的に小腸粘膜傷害の発生を軽減するが長期的には予防困難との報告があり,NSAIDs起因性小腸粘膜傷害を予防,治療する薬剤が望まれる.近年,本邦でミソプロストールやレバミピドなどを用いてアスピリンを含むNSAIDs起因性小腸粘膜傷害を抑制可能か調べる試験が行われ,有望な結果が得られている.今後,他の薬剤を含めて投与法,投与量,組み合わせなどの検討が望まれる.(著者抄録)

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

近年,ダブルバルーン内視鏡やカプセル内視鏡の普及に伴い,小腸には多彩な腫瘍が発生することが報告されている.本稿では発生頻度の高い悪性腫瘍を取り上げた.原発性小腸癌は腹部腫瘤やイレウス症状により,悪性リンパ腫は大半が腹部腫瘤により見つかることが多い.小腸GISTは原因不明消化管出血を契機に診断されることが多い.カルチノイドは本邦での発生頻度は非常に低いが,間欠的な腹痛により見つかることがある.現状では,小腸悪性腫瘍は症状がなければ診断が困難なため,診断時には進行していることが多い.予後の改善には早期発見が必須であり,小腸病変を疑う場合には,各種モダリティを組み合わせた積極的な小腸検査が必要である.(著者抄録)

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記述言語：日本語   出版者・発行元：(株)ヴァンメディカル  

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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)新興医学出版社  

カプセル内視鏡は低侵襲の小腸検査だが偶発症にカプセルの滞留がある。カプセル内視鏡は病変の指摘、観察に適していて、生検が治療ができるバルーン内視鏡と相補助な関係にある。原因不明消化管出血で出血が止まっているとき、診断効率面ではカプセル内視鏡が第一選択検査である。カプセル内視鏡では粘膜下腫瘍や憩室など粘膜に異常のない病変を指摘できないことがあり、腹部CTやバルーン内視鏡などを必要に応じて組み合わせる。カプセル内視鏡によりNSAIDs起因性小腸傷害が70%近いNSAIDs服用者に起こることが明らかになった。(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：(株)ヴァンメディカル  

カプセル内視鏡により、アスピリンを含むNSAIDsを常用する患者の60%以上に小腸粘膜傷害が生じていることがわかった。さらに、最近の研究で通常型NSAIDsを2週間服用しただけで潰瘍性病変を含む小腸傷害が60%近い対象者に生じることが明らかとなった。COX-2選択的阻害剤は短期的に小腸粘膜傷害を抑制するが、長期的には予防困難とする報告があり、NSAIDs起因性小腸粘膜傷害を予防、治療する薬剤が望まれている。近年、本邦でミソプロストールやレバミピドなどがアスピリンを含むNSAIDs起因性小腸粘膜傷害を抑制することが可能かどうかを調べる試験が行われ、有望な結果が得られている。今後、いずれの薬剤についても投与法、投与量、組み合わせなどの検討が望まれる。(著者抄録)

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

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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記述言語：日本語   出版者・発行元：(株)医学書院  

カプセル内視鏡やダブルバルーン内視鏡による,10mm以下の小さな小腸上皮性腫瘍に関しての報告を,遡及的に調査し現状を概説した.新しい小腸内視鏡検査が施行されている現状においても,臨床症状の出現が小腸の主な検査動機となっていることから,微小な病変は偶発的に認められたわずかな報告しか存在しない.症例の蓄積による小腸上皮性腫瘍の高危険群の設定が必要である.その際に内視鏡を含めた肉眼所見に関しても,コンセンサスの得られた共通の表現を用いて症例を集積する必要がある.(著者抄録)

DOI： 10.11477/mf.1403101683

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

Web of Science

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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：(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：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：(株)東京医学社  

カプセル内視鏡により、リウマチなどでNSAIDsを常用する患者の60%以上に何らかの小腸傷害が生じていることがわかった。カプセル内視鏡は苦痛がなく、非侵襲性が高いことから、複数回検査の受容性が高く、NSAIDsを中心とする薬剤の投薬前後に検査を行うことで、その小腸傷害を高い精度で知ることができる。最近の報告では、通常型NSAIDsを2週間服用しただけで、潰瘍性病変を含む小腸傷害が50〜60%近い対象者に生じることが明らかとなった。さらに、COX-2選択的阻害剤と通常型NSAIDsの小腸傷害に対する比較試験や、プロスタグランジンやレバミピドがNSAIDsの小腸傷害を抑制できるかどうかを調べる試験が行われ、新たな知見が明らかにされてきている。これらの研究から、NSAIDsの小腸傷害は一定の素因により増悪する可能性が高く、その素因の特定が望まれる。(著者抄録)

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記述言語：日本語   出版者・発行元：東京医学社  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2008352184

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：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

Web of Science

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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  

CiNii Books

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記述言語：日本語   出版者・発行元：(株)東京医学社  

わが国において、上部消化管出血における危険性は、アスピリンで5.5倍、通常型NSAIDで6.1倍も増加すると報告された。また、海外のVIGOR試験では通常型NSAIDにおいて、上部消化管出血は1.4%、下部消化管出血も0.89%で認められた。NSAIDsによる消化管副作用は上部消化管出血だけではなく、下部消化管出血も重要であることが示された。また、まだ報告は少ないが、原因不明消化管出血(OGIB)の10%程度はNSAIDs起因性の小腸出血によると考えられている。NSAIDsによる主な小腸障害は潰瘍性病変であり、その特殊型として膜様狭窄がある。海外だけでなく、わが国においても2週間の通常型NSAIDの連続投与で50%以上の健常人に潰瘍性の小腸粘膜障害が発生することが確認された。COX-2選択的阻害剤には、通常型NSAIDの消化管障害を軽減させることが期待され、海外では良い結果が示されているが、わが国における検討はこれからである。(著者抄録)

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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：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：BLACKWELL PUBLISHING  

Web of Science

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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  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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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：(株)日本メディカルセンター  

カプセル内視鏡(VCE)とダブルバルーン内視鏡(DBE)の開発により,小腸疾患の診断,治療は目覚ましい進歩を遂げた.本稿では両検査法の適応疾患,禁忌,偶発症,前処置や鎮静法について概説する.いずれも原因不明の消化管出血がもっとも多い適応となっている.滞留がVCEの唯一の偶発症であり,狭窄,瘻孔例は禁忌となっているため,DBEのみに適応がある.とくにDBEは組織学的検査のほか,止血処置,狭窄部位の拡張,異物回収などのさまざまな内視鏡治療も可能であるため,DBEが施行可能な環境であれば,今後狭窄症例に対してもVCEの適応が広がる可能性があると思われる.一方DBEの偶発症として,従来の内視鏡に伴うものに加え,急性膵炎の発症が少数報告されている.短時間で愛護的に行えば,比較的安全な検査法と思われる.今後両者のさらなる普及のためには,安全性を含めた明確なガイドラインの作成が望まれる.(著者抄録)

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記述言語：日本語   出版者・発行元：医歯薬出版  

CiNii Books