Chiho Makidono

Helicobacter pylori eradication reduced the incidence of gastric cancer, especially of the intestinal type

Although Helicobacter pylori infection is closely associated with gastric cancer development, follow‐up studies after H. pylori eradication are still scarce.

Therapeutic Efficacy of Leukocytapheresis in a Pregnant Woman with Severe Active Ulcerative Colitis

Leukocytapheresis has recently been used to induce remission in patients with ulcerative colitis (UC) who fail to respond to corticosteroids. We could not find a report in the literature on leukocytapheresis for UC with gestational exacerbation. We have recently encountered this unique condition and report the details here. A 30-year-old Japanese woman with left-sided severe UC was corticosteroid-dependent and had recurrence of the active disease during tapering of corticosteroid. She declined any dose increase and the use of any immunosuppressive agent because she was in the 13th week of pregnancy. Then, concomitant leukocytapheresis was performed without increasing the corticosteroid dose. Recovery was rapid and dramatic. Mucous and bloody stool decreased after the first session, and she had remission 2 weeks later. She underwent a total of four sessions without complications. After 6 weeks, she was discharged from our hospital and underwent maintenance treatment as an outpatient with mesalazine and corticosteroid tapering. Subsequently, she gave birth to a healthy baby girl by an uncomplicated vaginal delivery while keeping the remitted stage of UC.

Stool decay-accelerating factor as a marker for monitoring the disease activity during leukocyte apheresis therapy in patients with refractory ulcerative colitis.

Background and Aims:  We have shown previously that concentrations of stool decay‐accelerating factor (DAF; CD55), a complement regulatory protein, in patients with ulcerative colitis (UC) are increased in relation to the severity of the colonic mucosal inflammation. In the present study, we evaluated the usefulness of stool DAF as a marker for monitoring disease activity in patients with steroid‐resistant active UC being treated with leukocyte apheresis performed with a centrifugal cell separator.

Complement regulatory proteins in normal human esophagus and esophageal squamous cell carcinoma.

Background:  Altered expression of three complement regulatory proteins, decay‐accelerating factor (CD55), membrane cofactor protein (CD46) and homologous restriction factor 20 (CD59) has been identified in human gastrointestinal malignancies, but their expression in esophageal cancer has not been described. Therefore the purpose of the present paper was to study the distribution of these proteins in human normal and malignant esophageal mucosa.

Endoscopic therapy for bleeding esophageal varices improves the outcome of Child C cirrhotic patients

Background and Aim:  Bleeding from esophageal varices is one of the frequent severe complications arising in patients with liver cirrhosis. The management of esophageal varices is therefore important for patient survival. The purpose of this study was to clarify the predictive factors for mortality in patients with Child C cirrhosis presenting with variceal bleeding.

Centrifugal leukocytapheresis therapy for ulcerative colitis without concurrent corticosteroid administration.

Abstract:  Corticosteroid administration is an important therapy for active ulcerative colitis. However, long‐term corticosteroid use is associated with serious complications such as osteoporosis, diabetes, and growth retardation. The effect of combination therapy corticosteroid plus leukocytapheresis has been previously reported, but that of leukocytapheresis with no corticosteroid is unknown. We carried out a preliminary study of six patients (two men and four women) with active ulcerative colitis (severe in two, moderately severe in four) who did not respond to 5‐aminosalicylate derivatives, but refused corticosteroid use. Centrifugal leukocytapheresis was carried out once per week totaling four sessions per course. Treatment was considered effective when patients experienced clinical remission, which was defined as a frequency of diarrhea of four times or less and absence of visible blood in the stool, after one course. Leukocytapheresis was effective in five of six patients(83%). With cases stratified by severity, both severe cases and three of four moderately severe cases showed effectiveness. Clinical activity scores according to Lichtiger et al. in cases where leukocytapheresis was effective decreased from 9.8 to 6.6 at 1 week (P < 0.0001), declining further 2.4 at the end of the course. No obvious complications of leukocytapheresis were noted except for a decrease in hemoglobin by 1 g/dL. Centrifugal leukocytapheresis without corticosteroid treatment can induce remission in patients with active ulcerative colitis, and might be particularly beneficial for patients in whom adverse effects preclude the use of corticosteroids.

Does Treatment of Endoscopic Therapy for Esophageal Varices Improve Child C Cirrhosis Patient's Prognosis?

Does Treatment of Endoscopic Therapy for Esophageal Varices Improve Child C Cirrhosis Patients Prognosis? Shinichiro Hori, Hiroyuki Okada, Akiko Fujiwara, Ryuta Takenaka, Chiho Makidono, Motowo Mizuno, Yasushi Shiratori Purpose: Bleeding from esophageal varices is one of the frequent severe complications in patients with liver cirrhosis. We had defined this study to classify the factors predictive for mortality in Child C cirrhosis patients with risky esophageal varices.Methods: Consecutive 111 patients with both risky esophageal varices and with Child C stage patients from 1985 and 2003 were examined. Bleeding patients underwent emergency endoscopic screlotherapy (EIS) or endoscopic variceal ligation (EVL). We then analysed successful rate and parameters (T.Bil 3mg/dl, Age>60, gender, Alb ,EISVSEVL) predictive for a 6-week survival using Cox’s Proportional Hazard Model. In addition, we analysed the parameters predictive for mortality in 111 patients underwent endoscopic therapy for risky esophageal varices. Result: There were 88 (79%) men and 23 (21%) women, with mean age of 69 y.o (30-81 y.o). Hepatocellurer carcinoma (HCC) was detected in 62 patients. (56%) Endoscopic therapy (EIS and EVL) was successfully done in 52 patients with 94% efficacy. Efficacy of endoscopic theperapy was not different between EIS and EVL (p=0.73). T.Bil level of >3mg/dl is an only parameter (Odds ratio=5.33, 95%CI=1.4-20.4) predictive for a 6-week survival in 52 patients with acute bleeding from esophageal varices. Furthermore, the factors predictive for mortality in 111 Child C cirrhosis patients underwent endoscopic therapywereT.Bil level of>3mg/dl (OR=2.34, 95%CI=1.28-4.26), the presence of uncontrollable ascites (OR=3.17, 95%CI=1.34-7.52), and encephalopathy (OR=1.82, 95%CI=1.06-3.53), and the presence of HCC (OR=2.72, 95% CI=1.52-4.88). Conclusions: Endoscopic therapy for acute bleeding from esophageal varices is effective. ****401 The Limitations of Endoscopic Mucosal Resection in Barrett’s Esophagus Jason Lewis, Lori Lutzke, Thomas Smyrk, Kenneth Wang Endoscopic mucosal resection has been utilized to aid in the diagnosis and treatment of significant neoplastic lesions in Barrett’s esophagus (BE). Aim: To determine the ability of endoscopic mucosal resection to remove and diagnose significant dysplasia in Barrett’s esophagus.Methods:We assessed the results of all EMRs performed in the Barrett’s Esophagus Unit by an experienced endoscopist. EMRs were performed using two techniques. All lesions were injected with 1-15 mL of 1:100,000 adrenaline. A variceal band was used in the BAND technique while a specially fitted cap was used in the CAP technique. Biopsies were taken of any Barrett’s tissue seen. Resected specimens had their margins inked and submitted for histologic interpretation. All EMR specimens and biopsies were reviewed by two experienced pathologists who determined the deep and lateral margins of the EMRs. Results: From 1996 to 2003, 149 patients had 1-5 EMRs for a total of 240 resections. The pre-EMRdiagnoses were no BE in 2.5%, BEwith no dysplasia (ND) in 2.5%, BE with low grade dysplasia (LGD) in 7%, BE with high grade dysplasia (HGD) in 57%, and carcinoma of indeterminate depth in 31%. EMRwas performed with CAP in 77%of the cases and BAND in 23%. Themean size of the EMRwas 1.23 0.93 0.6cm. The post-EMR diagnosis was no BE in 34 cases (14%), ND in 22 cases (9%), LGD in 24 cases (10%), HGD in 88 cases (37%), intramucosal adenocarcinoma (IMAC) in 32 cases (13%), and invasive adenocarcinoma in 40 cases (17%). Margins were positive (involved by at least LGD) in 12 of the LGDs (50%), 72 of the HGDs (82%), 31 of the IMACs (97%), and 38 of the invasive carcinomas (95%). Among EMRs with no BE or BE with ND, additional biopsies obtained during the procedure showed dysplasia in 30% of 27 and 23% of 13 cases, respectively. Among the EMRs with LGD, at least HGDwas present in 39%of 18 additional biopsies. However, higher-grade lesions were not identified in biopsies in which the EMR diagnosis was HGD, IMAC, or invasive carcinoma. Conclusions: EMR for BE related dysplasia is a useful diagnostic tool because it does provide more information about depth of invasion than endoscopic biopsy. However, it does not completely resect neoplastic lesions in the majority of cases and additional biopsies are needed to exclude more significant disease.