Hisashi Furusu

High‐dose rabeprazole–amoxicillin versus rabeprazole–amoxicillin–metronidazole as second‐line treatment after failure of the Japanese standard regimen for Helicobacter pylori infection

Background : There is currently no optimal second‐line treatment after failure of Helicobacter pylori triple therapy.

5-day vs. 7-day triple therapy with rabeprazole, clarithromycin and amoxicillin for Helicobacter pylori eradication.

To determine whether a 5‐day regimen with rabeprazole, clarithromycin and amoxicillin (RCA) was as effective as a 7‐day regimen.

Development of hepatocellular carcinoma in a patient with chronic hepatitis C after 6 years of a sustained and complete response to IFN-alpha.

The authors report a rare case of hepatocellular carcinoma (HCC) that developed 6 years after a sustained and complete response to interferon (IFN) therapy for chronic hepatitis C. A 61-year-old Japanese man presented with a mass in the liver that was diagnosed as HCC. Six years earlier he was treated with IFN-alpha and responded successfully to therapy, with sustained normalization of serum aminotransferases and eradication of serum hepatitis C virus (HCV)-ribonucleic acid (RNA). HCV-RNA was also not detected in the resected tumorous and nontumorous liver tissues. The findings suggest that all patients with chronic HCV infection should be followed closely for as long as possible for the potential development of HCC even after a complete and sustained response to IFN treatment.

Lafutidine, a Novel Histamine H2-Receptor Antagonist, vs. Lansoprazole in Combination with Amoxicillin and Clarithromycin for Eradication of Helicobacter pylori

Background. In contrast to the growing amount of data concerning proton pump inhibitor‐based triple therapy for Helicobacter pylori infection, it is still controversial whether proton pump inhibitor can be replaced by H2 receptor antagonist without compromising efficacy. Lafutidine is a novel potent H2 receptor antagonist with gastroprotective activities such as enhancement of gastric mucosal blood flow.

Ulcerative colitis complicating pseudomembranous colitis of the right colon.

Clostridium difficile toxin was positive in the feces. The administration of vancomycin in addition to oral steroids resulted in rapid improvement of the condition. Total colonoscopy is recommended for precise diagnosis when patients with ulcerative colitis develop intractable diarrhea during or after antibiotic therapy.

Enhanced expression of transcription factor E2F in Helicobacter pylori-infected gastric mucosa.

Objective. Helicobacter pylori is implicated in gastric carcinogenesis through increased gastric epithelial cell turnover. In fact, high proportions of proliferating and apoptotic epithelial cells are found in H. pylori‐infected gastric mucosa. E2F, a transcription factor, induces coordinated transactivation of a set of genes involved in cell cycle progression. The aim of this study was to investigate the expression of E2F in H. pylori‐infected gastric mucosa and examine the correlation between such expression and gastric epithelial cell proliferation and apoptosis.

Five minute endoscopic urea breath test with 25 mg of 13C-urea in the management of Helicobacter pylori infection

Objective The endoscopic 13C-urea breath test (13C-EUBT), which combines the urea breath test (UBT) with endoscopy, provides high accuracy for the detection of Helicobacter pylori. This study was conducted to determine whether the 13C-EUBT using low doses of urea and short sampling times could preserve accuracy in the management of H. pylori infection. Methods Three hundred and twenty-five patients were randomized to receive the EUBT with 100, 50 or 25 mg of 13C-urea by endoscopic spraying. The breath samples collected at 5, 10 and 20 min were analysed using an isotope selected non-dispersive infrared spectrometer. H. pylori infection was assessed by the rapid urease test and histology. In each sampling schedule and protocol, cut-off values were calculated by a receiver operating characteristic curve. We applied the EUBT with 25 mg of 13C-urea at 5 min to the assessment of H. pylori eradication in 135 patients who had received the antimicrobial treatment or to the detection of the organism in 61 patients with previous partial gastrectomy. Results Based on histology and the urease test, patients who had discordant results were excluded from the analysis. Using 100 mg of urea, the sensitivity and specificity of the test were both 100% at 10 and 20 min, and the sensitivity and specificity at 5 min were best with 98.6% and 100%, respectively. With 50 mg, they were both 100% at 20 min, and the best combination of sensitivity and specificity at 5 and 10 min was 97.3–96.6% and 97.3–100%, respectively. Even with 25 mg, the sensitivity and specificity were both 100.0% at 20 min, and at the 5 min and 10 min time point, the EUBT yielded a sensitivity of 98.7% and a specificity of 100%. There was a significant positive correlation between the test values of the 5 min 13C-EUBT with 25 mg of test urea and those of the conventional UBT. The 5 min EUBT with 13C-urea offered high accuracy in the assessment of H. pylori eradication, with the sensitivity and specificity being 100% and 96.4%, respectively. In patients with previous gastrectomy, the EUBT provided acceptable accuracy (a sensitivity of 96.4% and a specificity of 97.0%). Conclusions Our results indicate that the 13C-EUBT is an accurate method for detecting H. pylori infection. The EUBT using only 25 mg of 13C-urea at the early (5 min) time point has satisfactory diagnostic efficacy in pre- and post-eradication treatment settings, providing a less expensive and more rapid way of performing the test. The EUBT may be a reliable method of assessing H. pylori status in the remnant stomach.