Makoto Moritani

Prevalence of endoscopically negative and positive gastroesophageal reflux disease in the Japanese

Objective. The frequency of gastroesophageal reflux disease (GERD) has not been fully investigated in the Asian population. The aim of this study was to investigate the prevalence of GERD, endoscopy-negative GERD (NERD), and erosive GERD in Japan, and the factors influencing disease prevalence. Material and methods. A total of 2760 subjects (mean age 50.4 years, range 24–84 years) were prospectively enrolled in this multicenter study. GERD symptoms were assessed with the Japanese version of the Carlsson-Dent self-administered questionnaire (QUEST) and upper gastrointestinal endoscopy was performed on all study participants. Results. A total of 495 (17.9%) individuals were diagnosed with GERD by the presence of erosive esophagitis at endoscopy and/or by the presence of GERD symptoms. Erosive esophagitis was diagnosed endoscopically in 195 (7.1%), and symptomatic GERD was diagnosed in 351 (12.7%) based on a QUEST score of over 6. Of these 351 subjects, 300 (10.9%) were considered to have NERD. Male gender, hiatal hernia, and mild gastric mucosal atrophy were significant positive predictive factors of erosive esophagitis by multiple regression analysis. Hiatal hernia was the only significant predictor of GERD symptoms. Traditional Japanese foods, such as sweet cakes and rice cake, frequently exacerbated GERD symptoms. Conclusions. The prevalence of GERD in the Japanese was 17.9% and the prevalence rates of NERD and erosive esophagitis were 10.9% and 8.6%, respectively. The majority of symptomatic patients did not have endoscopically proven esophagitis. Hiatal hernia is the only important predictor of the presence of GERD symptoms.

Co-infection by serologically-silent hepatitis B virus may contribute to poor interferon response in patients with chronic hepatitis C by down-regulation of type-I interferon receptor gene expression in the liver

Intrahepatic mRNA levels of type‐I interferon (IFN) receptor genes have been shown to correlate with the clinical efficacy of IFN therapy in patients with chronic hepatitis C. Recently, co‐infection by serologically‐silent hepatitis B virus (HBV) has been assumed to be associated with the poor IFN response in patients with chronic hepatitis C. The aim of this study was to investigate the relationship between the co‐infection of serologically‐silent HBV and type‐I IFN receptor gene expression in the liver of patients with chronic hepatitis C. The intrahepatic mRNA levels of IFNAR2, one of the two subunits of the type‐I IFN receptor, were quantified and compared with both the prevalence of HBV DNA and the hepatitis C virus (HCV) genotype in 45 patients with chronic hepatitis C, who were negative for hepatitis B surface antigen. Co‐infection, as evaluated by a nested polymerase chain reaction, was present in 22 patients (48.9%), with dominance of the HCV genotype 1b (65.2%) over genotype 2a (31.8%). Co‐infection was associated with lower IFNAR2 mRNA levels, higher levels of serum HCV RNA, and a poor IFN response, regardless of the HCV genotype. The findings suggest the possibility that co‐infection by serologically‐silent HBV is one of the factors that can lead to an unfavorable IFN response in chronic hepatitis C by down‐regulation of IFN receptor gene expression in the liver. J. Med. Virol. 63:220–227, 2001.

Changes in serum lipid concentrations in patients with chronic hepatitis C virus positive hepatitis responsive or non-responsive to interferon therapy.

Background: Changes in serum lipid concentrations during the administration of interferon to patients with chronic hepatitis C virus (HCV) infection have not been fully investigated. The present study was designed to compare changes in serum lipid concentrations before, during and after interferon therapy in responders and non‐responders to treatment.

A study of arteriosclerosis in healthy subjects with HBV and HCV infection.

BackgroundIt is unclear whether infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) affects arteriosclerosis. We performed a cross-sectional study to clarify the effect of HBV and HCV infection on arteriosclerosis.MethodsThe study subjects were 1806 healthy individuals who visited Shimane Environment and Health Public Corporation for routine medical check-ups. Serum levels of total cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides, and blood glucose were investigated in all subjects. The degree of arteriosclerosis was assessed using systolic blood pressure, the bilateral ankle brachial index (ABI), the heart-carotid pulse wave velocity (HCPWV), and the heart-ankle PWV (HAPWV). These cardiovascular parameters were compared between control subjects and subjects with HBV and HCV infection, using analysis of covariance to adjust for confounding factors (sex, age, body mass index, and smoking and drinking).ResultsOf the 1806 subjects, 39 and 31 were diagnosed as positive for HBV and HCV infection, respectively. The remaining 1736 were considered to be the controls. Adjusted serum lipid levels in the subjects with HBV and those with HCV infection tended to be lower than those in the control subjects. Adjusted arteriosclerotic parameters in the subjects with HBV and HCV infection were similar to those in the control subjects, even after adjusting for serum lipid levels.ConclusionsInfection with HBV or HCV does not influence the severity of arteriosclerosis in healthy subjects.

Report of a case showing a recovery from liver cirrhosis to chronic hepatitis, type C, after glycyrrhizin injection for 2 years and a sustained response by the following interferon therapy.

TO THE EDITOR: We read with great interest the article recently published by Schepke et al. (1), which demonstrates that Doppler assessment of portal vein flow velocity allows an accurate distinction between responders and nonresponders to propranolol acute administration compared with hemodynamic assessment. This is an important step in the field of treatment of portal hypertension, because hemodynamic evaluation is a relatively safe but still invasive technique and not as available as Doppler. At the end of the article the authors advocate the need for studies correlating Doppler parameters with clinical endpoints such as variceal bleeding. We here remark on our experience in this field. On the basis of a previous study, demonstrating a peak effect on portal flow velocity between 2 and 4 h after administration of 40 mg p.o. of propranolol (2), we conducted a prospective study on cirrhotic patients with esophageal varices at high risk of bleeding. This study, presented in the 49th ASSLD meeting in 1998 and published in 1999 (3), demonstrated that the portal flow velocity test was a safe and feasible method to predict the efficacy of b blockers in the prevention of a first variceal bleeding. A

Partial obstruction of the colon caused by postoperative adhesions after cholecystectomy as a rare form of postcholecystectomy syndrome

12% decrease in maximal portal flow velocity after propranolol acute administration was the best cutoff value with respect to efficacy of subsequent chronic treatment in preventing variceal bleeding, with a sensitivity of 69% and a specificity of 70%. Notwithstanding some methodological problems, our findings, also discussed by Garcia-Tsao (4), are clinically relevant and find further scientific support in Schepke et al.’s data. The slight difference between the cutoff point values reported in the two studies may be the consequence of the different endpoints and of operator and technical factors. It should be mentioned that the mean acute variation in portal flow velocity after the administration of b blocker reported in the literature ranges from 211.2% to 220.4% (5). We propose that the portal flow velocity test be used for response to propranolol administration before starting chronic therapy. If there is not a significant decrease in maximal portal flow velocity, the patient is a nonresponder and will not derive any clinical benefit, so the clinician should supplement or change the therapeutic approach.

Letter to the editorAge-related indications and complications after diagnostic laparoscopy

nously) and mesalamine (3.2 g/day per os). During the following days his general situation improved markedly. Computed tomography of the abdomen and transdermal ultrasonography confirmed the involvement of many bowel loops corresponding to the involved terminal ileum and cecum. On the next days his general situation improved markedly and he was discharged from the hospital after 20 days in good condition. One month later, except for the palpation of a hard mass in the right ileal fossa, no other abnormality on physical examination or laboratory investigation could be identified. The patient continued to be on ornidazole 500 mgb.i.d. per os. He was advised to continue the drug at the reduced dose of 500 mg/day for a few months. The patient was seen again on September 1999 for an episode of abdominal pain accompanied by four to six watery bowel movements per day due to Salmonella infection. It was a great surprise for us to realize that the patient continued receiving ornidazole 500 mg/day (some times 1000 mg/day) continuously, all these years. He received the drug without medical knowledge or advice because he thought that he must receive it indefinitely as a maintenance treatment. Diarrhea was settled promptly as was not related to Crohn’s disease itself. Liver and renal function tests were normal. No abnormality on the peripheral blood picture was noticed. The patient was advised to stop the drug immediately. Nitroimidazoles (metronidazole, ornidazole, and tinidazole) are well known drugs for their efficacy against anaerobes, giardia lamblia, and protozoal infections ( Trichomonas vaginalisand amoebic). They are well absorved from the gastrointestinal tract, including the rectum (7, 8). Therapeutically effective concentrations have been demonstrated in the central nervous system, bile, and peritoneal fluid. The elimination half-live of ornidazole has been estimated to be 14–15 h (8). Ornidazole has been used on patients with Crohn’s disease with an acceptable rate of efficacy either for acute exacerbations (1, 2) or as a maintenance treatment (3). The most common side effects include symptoms of the gastrointestinal system such as nausea, metallic taste, and vomiting. Other minor side effects such as dizziness, headache, urticaria, and ataxia have also been reported. However, there is always a fear of development of peripheral neuropathy in patients receiving this drug for a period longer than 3 or 6 months (9). It is well accepted that peripheral neuropathy is timeand dose-related. In one study (10), metronidazole at a dose of 800 mg daily for several months produced no clinical or laboratory signs of peripheral neuropathy. To the best of our knowledge ornidazole has never been administered for a.12 months (1, 3). Our patient received the drug continuously for a period.10 yr. Fortunately, he did not develop liver or renal disturbances or significant hematological abnormality. We suggest that the relatively low dose of ornidazole (500 mg/day) could explain the absence of toxicity. We conclude that ornidazole may not produce either peripheral neuropathy or dysfunction of vital organs in some patients, even if it is administered for 10 yr at a dose of 500 mg/day.

Coinfection with hepatitis C virus and TT virus in a case of late onset hepatic failure

TO THE EDITOR: Although the role of laparoscopy is thought to differ according to age group, systematic studies have not been reported to confirm this. It is also thought that life-threatening complications may differ with each age group. Therefore, we evaluated the role of laparoscopy and the rate of life-threatening complications in different age groups. Between 1981 and 1998 we performed 2432 laparoscopies. The numbers of patients in each age group were 65 for those aged 0.5–20 yr; 192, 21–30 yr; 304, 31–40 yr; 433, 41–50 yr; 674, 51–60 yr; 560, 61–70 yr; and 204, 71–87 yr. We reviewed all clinical data, all of the laparoscopy photographs, and records of the procedures of these patients. Statistical evaluations were performed by 2 test followed by Spearman rank correlation to compare the frequencies in each age group and by only 2 test to compare the life-threatening complication rate between two groups; statistical significance was set at p < 0.05.

Are predictive laparoscopic findings for progression of viral liver diseases different between type B and C

TO THE EDITOR: Late onset hepatic failure (LOHF) is a unique form of hepatic failure that complicates encephalopathy 8–24 wk after the onset of hepatitis (1) and is only rarely caused by hepatitis C virus (HCV) infection (2, 3). We report the first case of LOHF in which HCV and the recently identified TT virus (TTV) (4) were proven as causal factors.

Hepatocellular carcinoma complicating HCV-negative autoimmune hepatitis without corticosteroid therapy.

Are predictive laparoscopic findings for progression of viral liver diseases different between type B and C?