Mari Fukuzawa

Helicobacter pylori infection and reflux esophagitis in young and middle‐aged Japanese subjects

Background and Aims:  Helicobacter pylori infection rates are reported to be high in people over the age of 40 years, but are decreasing in younger age groups. A negative correlation has been reported between H. pylori infection and reflux esophagitis (RE).

CLINICAL EVALUATION OF EMERGENCY ENDOSCOPIC HEMOSTASIS WITH BIPOLAR FORCEPS IN NON‐VARICEAL UPPER GASTROINTESTINAL BLEEDING

The present study was designed to evaluate the usefulness and safety of bipolar hemostatic forceps, known as a less invasive and highly safe means of thermal coagulation used for hemostasis in cases of non‐variceal upper gastrointestinal bleeding. This technique of bipolar forceps is simple, safe and unlikely to induce complications, and is therefore promising as a new technique of endoscopic hemostasis. The study involved 39 cases where hemostasis was attempted with bipolar forceps to deal with non‐variceal upper gastrointestinal bleeding, including 28 cases of gastric ulcer, six cases of duodenal ulcer, three cases of bleeding after endoscopic submucosal dissection (ESD), one case of Mallory‐Weiss syndrome and one case of postoperative bleeding from the anastomosed area. There were 34 males and five females, with a mean age of 63.6 years. Bipolar forceps were the first‐line means of hemostasis in cases of oozing bleeding (venous bleeding), pulsatile or spurting bleeding (arterial bleeding) and exposed vessels without active bleeding. The primary hemostasis success rate was 92.3%, and the re‐bleeding rate was 0%. In cases where the bleeding site was located along the tangential line or in cases where large respiration‐caused motions hampered identification of the bleeding site, hemostasis by means of coagulation was easily effected by application of electricity while the forceps were kept open and compressed the bleeding area. In addition, there were no complications. This technique of bipolar forceps is simple, safe and unlikely to induce complications, and is therefore promising as a new technique of endoscopic hemostasis.

Narrow‐band imaging on screening of esophageal lesions using an ultrathin transnasal endoscopy

Background and Aim:  Ultrathin transnasal endoscopy, used extensively in Japan, is considered to have inferior image quality and suction performance, and questionable diagnostic performance. So the aim of the present study was to compare the diagnostic performance of white light (WL) examination and non‐magnified narrow‐band imaging (NBI) examination in screening for esophageal disorders with ultrathin transnasal endoscopy.

Mucosal cutting biopsy technique for histological diagnosis of suspected gastrointestinal stromal tumors of the stomach

The Japanese Gastrointestinal Stromal Tumor (GIST) therapeutic guidelines recommend endoscopic ultrasound‐guided fine‐needle aspiration biopsy for histological diagnosis. However, before 2010, this technique was only carried out at a minority of medical institutions in Japan. In the present study, we investigated the usefulness of mucosal cutting biopsy.

Correlation between Helicobacter pylori infection and low‐dose aspirin use on damage of the upper gastrointestinal tract

Background and Aim:  Low‐dose aspirin (LDA), and Helicobacter pylori (HP) infection are considered the two primary causes of peptic ulceration. The interaction between HP infection and non‐steroidal anti‐inflammatory drugs is, however, a matter of considerable discussion and controversy. In this study, we investigated possible synergistic or negative interactions between HP infection and LDA in gastric mucosal lesions, according to lesion site.

The role of trefoil factor family in apparently healthy subjects administrated gastroprotective agents for the primary prevention of gastrointestinal injuries from low-dose acetylsalicylic acid: a preliminary study

It is well-known that acetylsalicylic acid induces gastrointestinal complication. Recently, trefoil factor family has been reported as a mucosal protective factor. We focused on trefoil factor family as one of defensive system for gastrointestinal injuries. The aim of this trial was to evaluate trefoil factor family levels in the serum of healthy subjects with low-dose acetylsalicylic acid. Low-dose acetylsalicylic acid with placebo or proton pump inhibitor or rebamipide were administered in 30 healthy subjects. Transnasal endoscopy was performed at 0, 24 h, 3 and 7 day. Changing of trefoil factor family (1,2,3) and numbers of gastric injuries were evaluated. The numbers of gastric injuries were significantly increased in the placebo group at 3 and 7 days. Injuries in the proton pump inhibitor group were not induced, in the rebamipide group were slightly induced. Trefoil factor family level in the placebo group were decreased in 3 and 7 days compared with prior to starting the trial. Trefoil factor family may have an important association with acetylsalicylic acid-induced gastrointestinal damage. Proton pump inhibitor and rebamipide prevented low-dose acetylsalicylic acid-induced gastrointestinal complications compared with the placebo group.

Evolution of ultrathin endoscope

In Japan, the rapid spread of the use of transnasal ultrathin esophagogastroduodenoscopy (UT-EGD) has been reported. However, problems have been identified with poor endoscopic imaging quality. The new transnasal ultrathin scope (GIF-XP290N; Olympus Medical Systems, Tokyo, Japan) is equipped with the same high-resolution imaging as the GIFH260Z (Olympus Medical Systems). We report two cases of gastric cancer using this new scope and compare them to the Hi-vision scope (GIF-H260Z; Olympus Medical Systems) without magnification. Case 1: Early gastric cancer (0-IIc, tub1, pT1a (M), ly0, v0, pHM0, pVM0) in the lesser curvature of the pre-pylorus. Under white light observation, we detected a depressed lesion with decoloration, but the lateral margin of the lesion was unclear. In contrast, narrow-band imaging (NBI) without magnification endoscopy showed an irregular surface pattern and a clear demarcation line using the GIFXP290N on close-up observation (Fig. 1). These endoscopic images were comparable with the images using the GIFH260Z (Fig. S1). Case 2: Early gastric cancer (0-IIa, tub1, pT1a (M), ly0, v0, pHM0, pVM0) in the lesser curvature of the pre-pylorus. Under white light observation, we detected a slightly reddish, flat lesion. NBI without magnification endoscopy showed an irregular dot-like surface pattern and showed the extent of the lesser curvature of this lesion using the GIFXP290N on close-up observation (Fig. 2). These endoscopic images were comparable with the images using the GIFH260Z (Fig. S2). The ultrathin scope has evolved and we will study more on its usefulness in diagnosis of the upper gastrointestinal tract.

Specific clones of Staphylococcus lugdunensis may be associated with colon carcinoma

Staphylococcus lugdunensis produces a tannase with activity that may be associated with the onset of colon carcinoma. To clarify this feature of colon carcinoma-associated S. lugdunensis, we obtained isolates from healthy subjects and patients with colon adenomas and carcinomas and analyzed their genetic backgrounds. In total, 40 S. lugdunensis isolates from 288 rectal swabs collected between 2002 and 2008 were used. These isolates were classified into four groups according to the diseases of the subjects: healthy (n=13), colon carcinoma (n=13), colon adenoma (n=9), and unknown (n=5). The isolates were also classified by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing. In addition, an antimicrobial susceptibility test and detection of resistance genes were performed for all isolates. According to the PFGE analysis, 40 isolates could be classified into five groups. Among the groups, carcinoma and colon adenoma patients were significantly more frequently (40.9%) classified into group D (p<0.05), whereas healthy subjects were more frequently (38.5%) classified into group A. All isolates in group D were typed as ST27, which was clearly different than isolates in the other groups. All isolates were susceptible to the antimicrobial agents tested, including β-lactams, although seven strains produced β-lactamase. Our data suggest that a specific clone of S. lugdunensis might be associated with colon carcinoma and colon adenoma. This clone showed high susceptibility to many antimicrobial agents. Therefore, eradication therapy may lead to a decreased risk of colon carcinoma.