Hiroyuki Murao

Impact of double-balloon endoscopy on the diagnosis of jejunoileal involvement in primary intestinal follicular lymphomas: a case series.

In recent years, primary gastrointestinal follicular lymphoma has been increasingly detected in the duodenum on esophagogastroduodenoscopy (EGD). Primary gastrointestinal follicular lymphomas are frequently distributed to multiple sites in the gastrointestinal tract. Therefore, investigation into the spread of follicular lymphomas in the small bowel is important in order to determine the most appropriate treatment strategy. The performance of double-balloon endoscopy (DBE) in the diagnosis of jejunoileal follicular lymphoma lesions has not been fully evaluated. We aimed to investigate the value of DBE in addition to computed tomography (CT) and (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) in the diagnosis of jejunoileal follicular lymphoma. DBE with biopsy was performed in seven patients with primary duodenal follicular lymphoma diagnosed by EGD, in order to investigate jejunoileal involvement. Jejunoileal follicular lymphoma lesions were detected by DBE in six out of the seven patients (three in the jejunum and three in the jejunum and ileum), whereas CT and (18)F-FDG-PET failed to detect the existence of these lesions. Endoscopic findings of the jejunoileal lesions revealed multiple white nodules and white villi, which were similar to those of duodenal lesions. DBE was more useful for the diagnosis of jejunoileal involvement in primary intestinal follicular lymphoma than CT and (18)F-FDG-PET. The use of DBE will become important for determining the most appropriate treatment for gastrointestinal follicular lymphoma.

Multiple ulcers in the small and large intestines occurred during tocilizumab therapy for rheumatoid arthritis.

Tocilizumab is a monoclonal antibody against human interleukin-6 receptor which blocks the binding of interleukin-6 to its receptor. Tocilizumab is effective for the treatment of inflammatory disorders including rheumatoid arthritis. We report a case of multiple ulcers in the small and large intestines, which occurred during tocilizumab therapy. A 57-year-old woman started to use tocilizumab for rheumatoid arthritis. Three months later, she complained of hematochezia. Double-balloon endoscopy revealed multiple small aphthoid ulcers in the small and large intestines. One month after the woman had recovered, she was given tocilizumab again. The woman had hematochezia and abdominal pain again 2 weeks later. Colonoscopy revealed multiple round, discrete punched-out ulcers in the terminal ileum, and vast deep ulcers from the cecum to the descending colon. Bioptic histopathology and cultivation showed non-specific findings. Six weeks after discontinuation of tocilizumab, ulcers in the small and large intestine dramatically improved, leaving ulcer scars. This disease course and the results of examination made us strongly suspect that tocilizumab induced multiple ulcers in the small and large intestines. Interleukin-6 is a pleiotropic cytokine and involved in intestinal mucosal wound healing as well as in inflammatory processes. It is possible that tocilizumab inhibited tissue repair of the intestine and caused intestinal ulcers.

Gastric emptying in diabetic patients by the 13C-octanoic acid breath test: role of insulin in gastric motility

BackgroundImpairment of gastric emptying is well recognized in patients with diabetes mellitus (DM), especially long-standing insulin-dependent diabetes mellitus (IDDM). The aim of this study was to evaluate the cause of delayed gastric emptying in DM patients.MethodsIn 16 controls, 16 non-insulin-dependent diabetes mellitus (NIDDM) patients and 23 IDDM patients, gastric emptying was studied using the 13C octanoic acid breath test. Breath samples were taken before a test meal labeled with 100 mg of 13C octanoic acid, and at 15-min intervals over a 300-min period postprandially.ResultsIn all DM patients, the gastric emptying coefficient was lower than that in the controls (P < 0.05), and lag time and half-emptying time were significantly longer (P < 0.05). Both NIDDM and IDDM patients showed delayed 13CO2 excretion compared with the controls, but IDDM patients showed more delayed gastric emptying than NIDDM patients (P < 0.05). There were no significant differences in sex, HbA1c level, or the rate of neuropathy between the two groups.ConclusionsIDDM patients showed delayed gastric emptying compared with NIDDM patients, and the 13C octanoic acid breath test is useful for evaluating DM patients with delayed gastric emptying.

The 15-lipoxygenase-1 expression may enhance the sensitivity to non-steroidal anti-inflammatory drug-induced apoptosis in colorectal cancers from patients who are treated with the compounds

Background and Aim:  Non‐steroidal anti‐inflammatory drugs (NSAIDs) can prevent colorectal cancer (CRC), but their effect is limited. Recent studies have shown the involvement of 15‐lipoxygenase‐1 (15‐LOX‐1) in NSAID‐induced apoptosis in colorectal carcinoma cells. We evaluate whether 15‐LOX‐1 expression influences the sensitivity of NSAID‐induced apoptosis in CRCs.

Three cases of pedunculated gastric hamartomatous inverted polyps resected endoscopically

We report three cases of pedunculated gastric hamartomatous inverted polyps (HIPs) that were successfully treated by endoscopic polypectomy. The first case involved an 87-year-old woman with mild anemia. Esophagogastroduodenoscopy (EGD) revealed a pedunculated, reddish polyp located at the greater curvature of the upper stomach. The second case involved a 34-year-old woman in whom a pedunculated polyp was found at the gastric fundus during routine EGD. The third patient was a 59-year-old woman with epigastric discomfort. EGD revealed a pedunculated polyp in the gastric fundus. Polypectomy was successfully performed in all three cases. Histological examination revealed that the tumors comprised submucosal proliferation of cystically dilated gastric glands and hyperplastic glands;thus, we diagnosed gastric HIPs, which are rare and typically difficult to diagnose. Gastric HIPs should be considered in the differential diagnosis of elevated gastric lesions.

Synchronous gastrointestinal stromal tumors of the rectum and duodenum: A case report

An 85-year-old woman with anemia underwent colonoscopy, which revealed a 25-mm submucosal tumor with ulceration in the lower rectum. Histological examination of a biopsy showed that the lesion was a gastrointestinal stromal tumor (GIST). Subsequent esophagogastroduodenoscopy revealed a submucosal tumor in the duodenum, and examination of a biopsy obtained by endoscopic ultrasound-guided fine-needle aspiration also confirmed that this lesion was a GIST. The rectal lesion was surgically resected to control bleeding and was confirmed as a GIST histologically. Simultaneous development of GISTs in the rectum and duodenum is extremely rare.

W1928 Modulation of Smooth Muscle Cell Contractility by TH1/TH2 Cytokines in Gut Hyper-Contractility in a Murine Model of T Cell-Mediated Persistent Gut Motor Dysfunction

Background & Aims: Low grade gastrointestinal inflammation is a potent etiologic factor for developing irritable bowel syndrome. We have shown that Th1 and Th2 cytokines have opposing effect on intestinal muscle contraction via 5-HT signaling in the nematode infection and T cell-mediated enteropathy. In this study, we evaluated the gastrointestinal transit In Vivo and compared to the contraction study In Vitro, and investigated the effect of Th1/Th2 cytokines on smooth muscle cells (SMCs) in T cell-mediated persistent gut motor dysfunction model. In addition, we investigated the cytokine-induced intracellular signaling mechanism toward the gut motor dysfunction. Further, the improvement of hyper-contractility by a Japanese traditional medicine daikenchuto (DKT) (Kono T et al., Surgery 146:837-4

S1656 CD4+CD25+ Regulatory T Cells Suppress Both TH1- and TH17-Reactions in An Experimental Colitis

G A A b st ra ct s was determined in amultiplex immunoassay. Results: Prdx6 protein expression was decreased by acute and chronic colitis in wildtype as well as in Prdx6 overexpressing animals. No differences in the development of acute colitis could be observed between wildtype and Prdx6 overexpressing animals but Prdx6 knockout animals displayed lower histological scores in acute as well as in chronic DSS colitis. Prdx6 overexpressing animals on the other hand showed a higher histological score in the proximal colon after induction of chronic DSS colitis. In the chronic colitis model increased secretion of proinflammatory (e.g. TNFα, IL-6) as well as antiinflammatory (e.g. IL-10, IL-2, IL-4, IL-5) cytokines by mesenterial lymph node cells could be observed in Prdx6 knockout animals in comparison to wildtype animals whereas lower levels of these cytokines were secreted by mesenterial lymph node cells isolated from Prdx6 overexpressing animals. Conclusion: Our data suggest that effective defense against bacterial translocation by reactive oxygen species might ameliorate the course of DSS-colitis as Prdx6 knockout animals, in which less neutralization of ROS occurs, displayed lower histological scores in acute as well as in chronic colitis

T1778 Reciprocal Modulation of Smooth Muscle Cell Contractility in TH1 and Th2 Dominant Environments Using Murine Model of Early Post Inflammatory Gut Dysfunction

Background & Aim: In the enteric-infection-induced model of inflammation, Th1 and Th2 cytokines have opposing effect on intestinal muscle function and 5-HT signaling (Motomura et al. Gut 2008; Gastroenterology 128;Suppl A 626,2005), but the role of Th1 and Th2 dominant environments for non-infective post-inflammatory (PI) gut dysfunction remains to be determined. Here we investigated the mechanism for gut dysfunction that persists after acute inflammation in Th1 and Th2 dominant environments utilizing mouse model of T cell-induced enteropathy. Methods: BALB/c (Th2 dominant response) and AKR (Th1 dominant response) mice were treated with an anti-CD3 antibody (100 μg), and sacrificed at days 0, 1, 3, 7, and 14 post-treatment to investigate the histological changes, longitudinal smooth muscle cell contraction, various cytokines (Th1, Th2, Th17 cytokines), chemokines, and mediators mRNA /protein expressions and 5-HT-expressing enterochromaffin (EC) cells numbers in the small intestine. Results: In BALB/c mice small intestinal tissue damage was observed from 24 hours after the anti-CD3 antibody injection, but had resolved by day 5. Carbachol-induced smooth muscle cell contractility was significantly increased (p<0.05) from 4 hours after injection, and this muscle hypercontractility was evident (p<0.05) in the early PI phase (at day 7). Th2 cytokines (IL-4, IL-13) were significantly increased (p<0.05) from 4 hours to day 7 in the small intestine. EC cells in the intestine were significantly increased from day 1 to day 7 (p<0.05). On the contrary in AKR mice carbachol-induced smooth muscle cell contractility was significantly decreased from 4 hours after injection (p<0.05), and this muscle hypocontractility was evident until day 14. Th1 cytokines (IFNγ) were increased from 4 hours to day 7 in the small intestine. Conclusions: Intestinal muscle dysfunction in the early PI phase is maintained at the smooth muscle cell level. Th1 and Th2 cytokines have opposing effect on intestinal muscle contraction via 5-HT signaling in the early PI phase in this model. The gut dysfunctions in the early PI phase are influenced by Th1 or Th2 cytokine predominance environments.

Gastric emptying in diabetic patients by the 13

BackgroundImpairment of gastric emptying is well recognized in patients with diabetes mellitus (DM), especially long-standing insulin-dependent diabetes mellitus (IDDM). The aim of this study was to evaluate the cause of delayed gastric emptying in DM patients.MethodsIn 16 controls, 16 non-insulin-dependent diabetes mellitus (NIDDM) patients and 23 IDDM patients, gastric emptying was studied using the 13C octanoic acid breath test. Breath samples were taken before a test meal labeled with 100 mg of 13C octanoic acid, and at 15-min intervals over a 300-min period postprandially.ResultsIn all DM patients, the gastric emptying coefficient was lower than that in the controls (P < 0.05), and lag time and half-emptying time were significantly longer (P < 0.05). Both NIDDM and IDDM patients showed delayed 13CO2 excretion compared with the controls, but IDDM patients showed more delayed gastric emptying than NIDDM patients (P < 0.05). There were no significant differences in sex, HbA1c level, or the rate of neuropathy between the two groups.ConclusionsIDDM patients showed delayed gastric emptying compared with NIDDM patients, and the 13C octanoic acid breath test is useful for evaluating DM patients with delayed gastric emptying.