Hideki Koga

Treatment of ulcerative colitis by feeding with germinated barley foodstuff: first report of a multicenter open control trial

Background. Germinated barley foodstuff (GBF) is a prebiotic foodstuff that effectively increases luminal butyrate production by stimulating the growth of protective bacteria. In the first pilot study, GBF has been shown to reduce both clinical activity and mucosal inflammation in ulcerative colitis (UC). The aim of this study was to investigate the efficacy of GBF in the treatment of UC in a multicenter open control trial. Methods. Eighteen patients with mildly to moderately active UC were divided into two groups using a random allocation protocol. The control group (n = 7) were given a baseline anti-inflammatory therapy for 4 weeks. In the GBF-treated group (n = 11), patients received 20–30 g GBF daily, together with the baseline treatment, for 4 weeks. The response to the treatments was evaluated clinically and endoscopically. Fecal micro-flora were also analyzed. Results. After 4 weeks of observation, the GBF-treated group showed a significant decrease in clinical activity index scores compared with the control group (P < 0.05). No side effects related to GBF were observed. GBF therapy increased fecal concentrations of Bifidobacterium and Eubacterium limosum. Conclusions. Oral GBF therapy may have the potency to reduce clinical activity of UC. We believe that these results support the use of GBF administration as a new adjunct therapy for UC.

Small flat cancer of the rectum: Clinicopathologic and endoscopic features ☆ ☆☆ ★

The clinicopathologic and endoscopic features of 15 patients with small flat cancer of the rectum were investigated. Whereas 4 patients had hematochezia, the remaining 11 patients were asymptomatic, and stool positive for occult blood was the only remarkable clinical feature in 8 of them. Endoscopic features were slight elevation with central depression in 8 lesions, flat-topped elevation in 4, and shallow depression with irregular margin in 3. The surface of the tumor was often faint red in color and frequently characterized by mucosal friability. Five flat rectal cancers were missed during initial endoscopy, and they were found by repeated endoscopic examination. Three flat cancers were not identified in the distal rectum until retroflexed colonoscopic observation was performed. Although all tumors were smaller than 2 cm in diameter and 6 of them were under 1 cm, 9 lesions had deeply invaded the submucosal layer and 7 tumors showed lymphovascular permeation. Two lesions of 1 cm or greater had metastasized to perirectal lymph nodes. These results suggest that careful observation during endoscopy is necessary to detect flat rectal cancers, and a U-turn to examine the anorectal junction should be routinely done in the appropriate age group.

CASE REPORT: Does Metronidazole Cure Cap Polyposis by Its Antiinflammatory Actions Instead of by Its Antibiotic Action?: A Case Study

Cap polyposis (CP), which is histologically characterized by polyps consisting of elongated, tortuous and often distended crypts covered by a ‘cap’ of inflammatory granulation tissue, was first described by Williams et al. (1) in 1985. Some investigators have postulated that abnormal colonic motility leading to mucosal prolapse might cause this condition (2). A possible contribution of infections origin has also been suggested (3), but the precise mechanisms still remain unclear. Herein we describe a case of CP which was refractory to a broad spectrum antibiotic, but responded completely to metronidazole (MNZ).

Multiple granular cell tumors of the esophagus removed endoscopically: a case report

Granular cell tumors (GCT) are relatively rare neoplasms found mainly in the tongue, skin, and breast.1-4 However, in 1% to 8 % of cases GCT occur in the gastrointestinal tract,2,3 usually as solitary tumors.5 We describe a patient with four synchronous esophageal GCT, all successfully treated without complications by endoscopic removal. We review the literature concerning multiple esophageal GCT with particular attention to management.

Case of early gastric cancer with nodular gastritis

A case of depressed early gastric cancer with nodular gastritis is described. A 47‐year‐old Japanese man was referred to our hospital and admitted for surgical treatment of gastric cancer. Barium upper gastrointestinal study and endoscopy examination showed a 4.5 × 3.0 cm depressed lesion with a deep central ulceration in the anterior wall of the lower corpus. An unusual miliary pattern resembling ‘goose flesh’ was observed endoscopically in the antrum. Biopsy specimens from the tumor showed poorly differentiated adenocarcinoma, and specimens from the antrum showed many lymphoid follicles with a germinal center. Immunoglobulin G antibody and histological tests (Giemsa stain) for Helicobacter pylori were both positive. Early gastric cancer with nodular gastritis was diagnosed and a subtotal gastrectomy was performed. Histological examination of the resected specimen showed a stage I tumor infiltrating a poorly differentiated adenocarcinoma with a depressed lesion in the corpus (type 0 IIc + III) and nodular gastritis in the antrum. The patient is doing well 1 year after surgery.

The diagnostic yield of colonoscopy and the therapeutic value of intraduodenal amidotrizoic acid injection in intestinal Diphyllobothrium latum infection: report of a case.

The diagnostic yield of colonoscopy and the therapeutic value of intraduodenal amidotrizoic acid injection in intestinal diphyllobothrium latum infection: report of a case

Blockade of tumor necrosis factor-α-converting enzyme improves experimental small intestinal damage by decreasing matrix metalloproteinase-3 production in rats

Objective. Tumor necrosis factor (TNF)-α-converting enzyme (TACE), which has been purified, regulates maturity of TNF-α. Matrix metalloproteinases (MMPs) play a key role in various inflammatory conditions. The incidence of intestinal damage has increased, but the mechanism and treatment have not been well understood. The purpose of this study was to investigate the roles of TACE and MMP in indomethacin (Indo)-induced intestinal damage as well as the therapeutic effects of TACE inhibitor and selective MMP inhibitor (sMMPi) on this intestinal damage in rats. Material and methods. In the first experiment, serial changes in intestinal ulcers and the production of MMP were investigated. In the second experiment, we assessed the effect of three TACE and/or MMP inhibitors and the production of TNF-α, TACE, MMP-3, -9 and tissue inhibitor of MMP (TIMP)-1. The rats were divided into five groups: a control group, and four groups that received Indo alone, Indo plus TACE inhibitor (GM6001), Indo plus a selective MMP-3 inhibitor and Indo plus an MMP-9/13 inhibitor, respectively. Results. MMP-3 was overexpressed at 24 h after Indo administration, when intestinal injury was most prominent macroscopically and microscopically. GM6001 significantly decreased ulcer severity and suppressed MMP-3 in a dose-dependent fashion. The selective MMP-3 inhibitor dose-dependently ameliorated intestinal damage to the same degree as GM6001, but the MMP-9 inhibitor had no effect on the injury. Conclusions. MMP-3 inhibition ameliorates intestinal damage without apparently affecting either TNF-α or TACE production and the dose–response curve suggests that the beneficial effect of the so-called TACE inhibitor is actually mainly mediated via MMP-3 inhibition rather than TNF-α inhibition.

Helicobacter-independent, chemotherapy-resistant, radiosensitive gastric MALT lymphoma with massive deposits of amyloidlike substance.

Gastric lymphoma is a heterogeneous group of various clinicopathologic conditions. Mucosa-associated lymphoid tissue (MALT) lymphoma, which was first described by Isaacson and Wright (1) in 1983, has become a distinct entity in gastric lymphoma. For a long time, the treatment for gastric lymphoma has been surgical resection regardless of the clinicopathologic features (2). As for gastric MALT lymphoma, a causal relationship with Helicobacter pylori(Hp) infection has been indicated (3, 4), and antibiotic therapy to eradicate Hp has become the treatment of choice (5, 6). However, some gastric MALT lymphomas do not respond to Hp eradication. It remains controversial what the approach should be when Hp eradication proves ineffective. Recently, it has been reported that radiation therapy, which has been used frequently as an adjuvant therapy to other treatments, might become a primary therapy for gastric MALT lymphoma (7). Because radiation has more adverse effects than Hp eradication, the indications for radiation therapy should be carefully determined. We used radiation therapy for a patient with a gastric MALT lymphoma that had not responded to Hp eradication therapy, and which had further resisted single-agent chemotherapy and combined chemotherapy. Herein, we describe the

Characterization of secondary GI lesions with anaplastic large-cell (Ki-1) lymphoma: a first report of two cases

The gut is the most common site of all primary extranodal lymphomas, accounting for roughly 5% of nonHodgkin’s lymphoma. Anaplastic large-cell lymphoma (ALCL) is characterized by a cohesive, solid growth pattern of large lymphoma cells closely resembling anaplastic carcinoma and intense expression of CD30 (Ki-1) antigen in the neoplastic cells of Tand/or null-cell origin. ALCL can be divided into two major groups: anaplastic lymphoma kinase (ALK) positive and ALK negative. ALK expression, the result of a t(2;5) translocation, is strongly associated with younger age and a good prognosis. Primary gastric ALCL is found sporadically; the typical endoscopic finding is a large mass with ulceration similar to an advanced cancer. By contrast, secondary GI lesions with systemic ALCL are exceptionally infrequent, with only a few published reports. However, these reports do not focus on the GI lesions; furthermore, gastroenteric involvement by ALCL has not been reported. This report describes two patients with secondary GI involvement by ALK-positive systemic ALCL.

Suddenly accelerated growth of gastrointestinal stromal tumor of remnant stomach.

Gastrointestinal stromal tumors (GISTs) are pathologically divided into four categories: tumors showing differentiation towards smooth muscle cells, tumors showing apparent differntiation toward neural elements, tumors showing dual differentiation toward smooth muscle and neural elements, and tumors lacking differentiation toward either cell type (1). Most tumors formerly identified as leiomyomas or leiomyosarcomas of the stomach have recently been considered GISTs of category 1. A Japanese man who had undergone a distal gastrectomy 10 years earlier was diagnosed as having a small submucosal tumor of the remnant stomach. The tumor demonstrated no changes in size during the initial 6 months, but unexpectedly became larger rapidly thereafter. The resected tumor microscopically consisted of low-grade and high-grade malignant components. Herein we describe in detail this instructive case of a rapidly growing GIST of a remnant stomach.