Hitoshi Nakajima

ABSENCE OF MYCOBACTERIUM PARATUBERCULOSIS DNA IN INTESTINAL TISSUES FROM CROHN'S DISEASE BY NESTED POLYMERASE CHAIN REACTION

Abstract: A role of Mycobacterium paratuberculosis in Crohns disease has been suggested for many years. To determine whether Mycobacterium paratuberculosis has the potential to cause Crohns disease, we investigated Crohns disease tissues for the presence of Mycobacterium paratuberculosis, using highly sensitive nested polymerase chain reaction (PCR). DNA was extracted from samples of intestine obtained from 13 patients with Crohns disease, 14 patients with ulcerative colitis, and 13 control patients without inflammatory bowel disease. Nested PCR was performed using primer pairs complementary to sequences in the insertion element IS900 gene of Mycobacterium paratuberculosis. No Mycobacterium paratuberculosis-specific PCR product was detected in any of these specimens, although PCR products of the appropriate size were consistently obtained using control DNA template from Mycobacterium paratuberculosis. The results did not suggest that Mycobacterium paratuberculosis is involved in the pathogenesis of Crohns disease.

pH profile of esophagus in patients with inlet patch of heterotopic gastric mucosa after tetragastrin stimulation. An endoscopic approach.

In a series of 1771 endoscopic examinations from 1988 to 1990, we observed 62 cases (3.3%) of inlet patch of heterotopic gastric mucosa (IPHGM) in the upper esophagus. Ten of the IPHGM patients complained of throat discomfort or globus sensation, and these symptoms were relieved by histamine H2-antagonists, suggesting that these symptoms could be caused by acid secretion from IPHGM. Acidity under tetragastrin stimulation was measured in the esophagus and compared with the pool of gastric juice and saliva under direct vision by a newly devised endoscopic method. Congo red staining was also carried out after pH measurement. Significant pH reduction at IPHGM was observed in three cases, and black coloration with Congo red staining in the IPHGM was observed in four cases. These findings suggest that IPHGM is a mucosal change with latent acid secretion.

Extraintestinal cancers in Crohn's disease.

We have observed 4 cases of extraintestinal cancer complicating Crohns disease (CD). They included renal cancer, urinary bladder cancer, ovarian cancer and myeloma. A review of the literature showed a considerable number of reports of extraintestinal cancer complicating CD with a total of 75 further cases. The significance of those and our cases is discussed. The possibility of extraintestinal cancer must be kept in mind following patients with CD. Our report suggests there may be a nonnegligible risk of extraintestinal cancer, particularly genitourinary tumor, in CD. The causal relationship, if any, remains undetermined.

Difficulty in estimating localized bowel contraction by colonic manometry: a simultaneous recording of intraluminal pressure and luminal calibre

To examine whether or not intraluminal pressure changes at a site in the human colon reflect with fidelity the local bowel wall contractions or relaxation, endoscopic recording of the changes in colonic calibre as a parameter of the motor events with simultaneous manometry was performed at a fixed site in a prepared sigmoid colon during the interdigestive state. In four of the 12 subjects, a total of 20 phasic pressure waves with an amplitude of 13–22 mmHg and a duration of 13–18 sec were obtained in a 20 min recording session. Eighteen of the 20 phasic pressure waves (90%) were associated not with a decrease (contraction) but with an increase in the calibre (relaxation). The pressure change began 0.2–8.4 sec (mean: 4.5 sec) behind and ended − 1.8 to 8 sec (mean: 3.5 sec) ahead of the calibre change. In the other eight subjects, no phasic pressure change was recorded in the presence of an overt calibre change. We conclude that manometric phasic pressure change recorded at a site in the empty human colon is not necessarily correlated with the localized contractile activity. Extrapolation of pressure profiles in the colon to motor events at the manometric site should be cautious.

A New Method for Measurement of Gastric and Colonic Lesions with an Electronic Endoscope and Image Processor

In order to measure the sizes of gastric and colonic lesions endoscopically, we established a system composed of an electronic endoscope, image processor, and personal computer. The long and short diameter of the lesion were calculated by a program which corrected the curvature radius of the lens of the endoscope and variables. 1) To evaluate its accuracy, we measured a 10 mm scale spherical model at different distances from the lens of the endoscope. The mean value was 9.7 mm, ranging from 9.0 to 10.9 mm. The rate of error was –0.38±4.4 % (mean±SE). 2) Using this system, we measured the sizes of 34 gastric and colonic lesions in 34 patients (3 with gastric cancers, 20 with gastric polyps, and 11 with colonic polyps), and compared them with the real sizes of the resected or polypectomized specimens. The rate of error was–1.1±1.3% (mean±SE). The results showed that our system was useful to evaluate the accurate sizes of gastric and colonic lesions endoscopically.