Hidetoshi Kagaya

Non-Helicobacter pylori and non-NSAID peptic ulcer disease in the Japanese population.

Background Helicobacter pylori and non‐steroidal antiinflammatory drugs (NSAIDs) are recognized as the major causes of peptic ulcer disease. The status of H. pylori infection in the background population may influence the incidence of H. pylori‐negative peptic ulcer disease. Objective To examine the incidence of H. pylori‐negative peptic ulcer disease without intake of NSAIDs in Japan. Patients A total of 398 patients who had no eradication therapy for H. pylori prior to this study, including 246 patients with gastric ulcer (GU) and 152 patients with duodenal ulcer (DU), were enrolled. Methods H. pylori status was assessed by rapid urease tests, histological examinations (haematoxylin & eosin stain, Giemsa stain and/or immunostaining) and serum IgG antibody. Two biopsy specimens were taken from the antrum within 3 cm of the pyloric and two from the middle corpus of the stomach, along the greater curvature. Patients were asked a series of questions regarding risk factors, including the use of NSAIDs. The presence of gastritis, gastric atrophy and intestinal metaplasia was examined according to the updated Sydney system. Results Of the 246 patients with GU, 12 patients (4.9%) were considered to be H. pylori‐negative. Of the 152 patients with DU, two patients (1.3%) were considered to be H. pylori‐negative. Hence, a total of 14 patients were found to be H. pylori‐negative. Nine of them were taking NSAIDs. Consequently, the frequency of H. pylori‐negative ulcer without intake of NSAIDs was 1.3%. There was no significant difference in the frequencies of H. pylori‐negative patients between the GU and DU groups. Conclusion The incidence of H. pylori‐negative peptic ulcer disease without intake of NSAIDs was very low in the Japanese population. Eur J Gastroenterol Hepatol 12:635‐640

Efficacy of triple therapy with rabeprazole for Helicobacter pylori infection and CYP2C19 genetic polymorphism

Rabeprazole is a new, potent, proton pump inhibitor. The metabolism of rabeprazole is less dependent on CYP2C19 genetic polymorphism.

A prospective evaluation of new rapid urease tests before and after eradication treatment of Helicobacter pylori, in comparison with histology, culture and 13C-urea breath test.

BACKGROUND The rapid urease test is a simple and cost-effective method to detect Helicobacter pylori in biopsy specimens. The aim of this study was to evaluate the accuracy of two new rapid urease tests, Helicocheck and PyloriTek, before and after eradication. METHODS A total of 278 patients, including 115 patients who had not undergone eradication of H pylori and 163 patients after eradication treatment, were enrolled. Eight biopsy specimens were taken from both the antrum and the body of the stomach for histology, culture, and two rapid urease tests. Assessment of H pylori infection was determined by the combination of histology, culture, and (13)C-urea breath test. RESULTS Overall sensitivity, specificity, and positive and negative predictive values of the Helicocheck before eradication were 91.0%, 100%, 100%, and 62.5%; PyloriTek, 92.0%, 100%, 100%, and 65.2%. Those of Helicocheck after eradication were, respectively, 60. 5%, 99.2%, 95.8%, and 89.2%; PyloriTek, 60.5%, 99.2%, 95.8%, and 89. 2%. For the Helicocheck, determination of the infection status of H pylori by biopsies from the gastric body had a significantly higher sensitivity than antral biopsies. After eradication, the combination of 1 antral biopsy and 1 biopsy from the body was not effective enough to improve the overall sensitivity. CONCLUSIONS Helicocheck and PyloriTek have equally satisfactory overall sensitivity before eradication treatment. However, the sensitivity of these rapid urease tests was lower after eradication than before eradication.

High-dose ecabet sodium improves the eradication rate of Helicobacter pylori in dual therapy with lansoprazole and amoxicillin

The additive effect of ecabet sodium in combination with dual therapy on Helicobacter pylori eradication was evaluated.

Effects of lansoprazole plus amoxycillin on the cure of Helicobacter pylori infection in Japanese peptic ulcer patients

Aim: The effect of lansoprazole plus amoxycillin on curing Helicobacter pylori infection and peptic ulcer recurrence was evaluated.

Clinical efficacy of lansoprazole in eradication of Helicobacter pylori

A randomized, single-blind study was designed to assess the effect of lansoprazole alone and lansoprazole plus amoxicillin on the healing and eradication rates in Helicobacter pylori-associated peptic ulcer disease. Seventy-nine patients with gastric ulcers and 54 patients with duodenal ulcers were randomly assigned to two treatment groups. Group 1 received lansoprazole 30 mg daily for 8 weeks for gastric ulcers or 6 weeks for duodenal ulcers. Group 2 received the group 1 regimen plus amoxicillin 2 g daily for 2 weeks. Healing rates at 8 weeks for the gastric ulcer patients were 92 and 84% in groups 1 and 2, respectively (p = not significant). Healing rates at 6 weeks for duodenal ulcers were 96% in group 1 and 100% in group 2 (p = not significant). The eradication rates of H. pylori for gastric ulcer patients were 21 and 54% in groups 1 and 2, respectively (p < 0.05). The H. pylori eradication rates for duodenal ulcer patients were 5 and 73% in groups 1 and 2, respectively (p < 0.001). The H. pylori eradication rates in group 2 were significantly higher than in group 1. Lansoprazole was effective for eradicating H. pylori in this study.

Detection of cerebroside sulfotransferase mRNA in human gastric mucosa and adenocarcinoma

Sulfatide is a major acidic glycolipid in human gastric mucosa, and its sulfation is catalyzed by cerebroside sulfotransferase (CST). To investigate the expression of the CST gene in human gastric cancer, a reverse transcription PCR method was developed with the use of endoscopic bioptic specimens. By this method, we examined the CST mRNA expression in 11 cases of gastric cancer, and in all the cases we detected various levels of the expression both in cancer tissues and in uninvolved adjacent tissues. The present assay method was suggested to be useful in the detection of CST mRNA from a limited amount of bioptic samples.

Intestinal Obstruction due to Complete Transmural Migration of a Retained Surgical Sponge into the Intestine.

A 56-year-old woman with a history of gynecological surgery for cervical cancer 18 years previously was referred to our hospital for colicky abdominal pain, nausea and vomiting. Intestinal obstruction was diagnosed by contrast-enhanced computed tomography (CT) which showed dilation of the small intestine and suggested obstruction in the terminal ileum. In addition, CT showed a thick-walled cavitary lesion communicating with the proximal jejunum. 18F-fluorodeoxyglucose positron emission tomography showed abnormal uptake at the same location as the cavitary lesion revealed by CT. The patient underwent laparotomy for the ileus and resection of the cavitary lesion. At laparotomy, we found a retained surgical sponge in the ileum 60 cm from the ileocecal valve. The cavitary tumor had two fistulae communicating with the proximal jejunum. The tumor was resected en bloc together with the transverse colon, part of the jejunum and the duodenum. Microscopic examination revealed fibrous encapsulation and foreign body giant cell reaction. Since a retained surgical sponge without radiopaque markers is extremely difficult to diagnose, retained surgical sponge should be considered in the differential diagnosis of intestinal obstruction in patients who have undergone previous abdominal surgery.

Traditional and non-traditional antimicrobial agents for H. pylori infection.

Triple therapy with a proton pump inhibitor plus two antibiotics is recently standard regimen for treatment of H. pylori infection. However, the agents that are used for H. pylori eradication are not always limited to drugs whose primary use is as an antimicrobial agent. Anti-H. pylori activity has been reported for nontraditional antimicrobials such as proton pump inhibitors, bismuth compounds, mucosal defensive agents, and some other agents. Proton pump inhibitors and their acid-activated derivatives have significant activities against H. pylori, potent inhibitors of urease, proton motive force, and ATPase of H. pylori. Some bismuth compounds and compound of a mixture of ranitidine hydrochloride and bismuth citrate were shown to inhibit the growth of H. pylori in vitro, to eradicate H. pylori in vivo, and to decrease the development of H. pylori secondary resistance to antibiotics. The mechanism of bactericidal action of bismuth compounds has not been clear. Mucosal defensive agents that enhance defense factors of gastro-duodenal mucosa are locally acting anti-ulcer drugs. Each mucosal defensive agent was found to have direct or indirect different activities against H. pylori in vitro. Though studies attempting to improve the eradication rate by the addition of mucosal defensive agents to conventional therapy have been tried, additive effects of these agents were equivocal. Therapeutic approaches with other agents such as Lactobacillus, lactoferrin, and dietary constituents to cure H. pylori infection are under investigation. Non-traditional antimicrobials by them selves are unable to cure H. pylori infection in spite of anti-H. pylori activities. Studies are needed to establish the clinical utility of non-traditional antimicrobial agents in prevention and eradication of H. pylori infection since eradication of antibiotic resistance H. pylori would become a difficult problem.

Recurrence of peptic ulcer after successful eradication of Helicobacter pylori infection in the Japanese popultion: A prospective follow-up study

Background: Successful eradication of 11. pylori reduces the rate of duodenal ulcer (DU) relapses. Only a few studies in patients with gastric ulcer (GU) have been reported. Aim: To determine the recurrence rates of GUs or DUs after cure of H. pylori infection. Patients and Methods: A total of 236 patients who had successful eradication therapy, including 133 patients with GU, 89 patients with DU and 14 patients with gastro-duodenal ulcer (GDU), were enrolled in this study. Patients using nonsteroidal anti-inflammatory drugs (NSAIDs) at entry or taking maintenance antisecretory therapy after healing of ulcers were excluded. They were followed up endoscopically at 1, 3, 6 and every 12 months after the completion of eradication therapy and at any time when an ulcer symptom recurred, for assessment of ulcer healing and cure of 1-1. pylori infection. (mean follow-up period (range): 1.5 year (0.5 4.5 years)) Biopsy specimens were taken from both the antrum and corpus. H. pylori status was assessed by rapid urease tests, histological examination (hematoxyllin and eosin stain and Giemsa stain), culture and 13C-urea breath test. Results: