Jin Imai

Yogurt Containing Lactobacillus gasseri Mitigates Aspirin-Induced Small Bowel Injuries: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial

Background: Although there is evidence about the beneficial effects of probiotics, their effects on aspirin-induced small bowel injuries have not been well examined. We evaluated the effects of the probiotic Lactobacillus gasseri OLL2716 (LG) on aspirin-induced small intestinal lesions, such as ulcers, erosions, reddened lesions, and bleeding. Summary: This study enrolled 64 patients who received aspirin for more than 1 month and provided written informed consent to be part of the study. The patients received 112 ml of yogurt containing LG or placebo twice daily for 6 weeks. Small bowel injuries were evaluated by capsule endoscopy before and after consuming the yogurt. The effect of LG on patient symptoms was also assessed using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires before and after 6 weeks of treatment. There was no significant difference in any baseline characteristics and the number of small bowel mucosal breaks between the 2 groups. In contrast with the placebo group, the LG group had significantly fewer small bowel mucosal breaks and reddened lesions after 6 weeks (p < 0.01). The FSSG and GSRS scores were also significantly improved in the LG group but not in the placebo group. Key Messages: This double-blind, placebo-controlled study found that LG may be useful in reducing aspirin-induced small bowel injuries and in mitigating gastrointestinal symptoms.

Irsogladine maleate and rabeprazole in non-erosive reflux disease: A double-blind, placebo-controlled study.

AIM To evaluate the efficacy of adding irsogladine maleate (IM) to proton-pump inhibitor (PPI) therapy in non-erosive reflux disease (NERD) treatment. METHODS One hundred patients with NERD were recruited and randomized to receive rabeprazole plus IM (group I) or rabeprazole plus placebo (group P). The efficacy of the treatment was assessed using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) and the short form (SF)-36 quality of life questionnaires after four weeks of treatment. We also assessed whether patients with NERD with minimal changes (grade M) had different responses to the therapies compared with patients who did not have minimal changes (grade N). RESULTS Group I and group P showed significant improvements in their FSSG scores after the treatment (from 17.9 ± 7.9 to 9.0 ± 7.6, and from 17.7 ± 7.3 to 11.2 ± 7.9, respectively, P = 0.0001), but there was no statistically significant difference between the FSSG scores in group I and those in group P. Subgroup analysis showed that significant improvements in the FSSG scores occurred in the patients in group I who had NERD grade N (modified Los Angeles classification) (7.8 ± 7.4 vs 12.5 ± 9.8, P = 0.041). The SF-36 scores for patients with NERD grade N who had received IM and rabeprazole were significantly improved in relation to their vitality and mental health scores. CONCLUSION The addition of IM to rabeprazole significantly improves gastroesophageal reflux disease symptoms and the quality of the lives of patients with NERD grade N.

Non-traumatic Internal Oblique Muscle Hematoma

A 69-year-old obese man (body mass index, 30.3) presented with acute left abdominal pain after severe coughing. He had no history of direct abdominal trauma. He was not receiving anticoagulant therapy. A physical examination showed a smooth painful mass on his left abdominal wall. The laboratory findings were a platelet count of 196,000/ mm and a normal range of coagulability. Ultrasonography revealed a hypoechoic mass in the left lateral abdominal wall (Picture 1a). Unenhanced computed tomography showed a distensible high-density mass consisting of fluidfluid levels in the left internal oblique muscle (Picture 1b and c), and the transverse abdominal muscle was intact. Extravasation could not be evaluated because of his renal dysfunction. He was diagnosed with internal oblique muscle hematoma and was conservatively treated. Ecchymosis presented three days later on his left lateral abdomen (Picture 2). Spontaneous abdominal wall hematoma is considered to occur as a non-traumatic injury to vessels or muscles of the abdominal wall and has several risk factors, including overcontraction due to coughing or vomiting and weakness of the vessel wall as a result of hypertension, arteriosclerosis, obesity or pregnancy (1, 2). In spontaneous ab-

Acute Pleuritis Caused by Mesalamine.

A 28-year-old woman was diagnosed with ulcerative colitis based on colonoscopy findings (Picture 1). Mesalamine (3,600 mg per day) treatment was initiated to treat the patient’s ulcerative colitis. Ten days later, she was admitted our hospital with fever (38.8°C), a dry cough and chest pain. Laboratory tests showed the elevation of the patient’s white blood cell count (13,000/mm) and C-reactive protein level (11.0 mg/dL). Computed tomography (CT) revealed bilateral pleural effusions and patchy consolidations in the peripheral lung fields (Picture 2). At first, ceftriaxone was administered for five days; however, her respiratory symptoms showed continued deterioration. The mesalamine therapy was dis-