Miki Miura

A prospective randomized trial of either famotidine or omeprazole for the prevention of bleeding after endoscopic mucosal resection and the healing of endoscopic mucosal resection‐induced ulceration

Background : It has been reported that inhibitors of gastric acid secretion prevent bleeding after endoscopic mucosal resection for mucosal gastric neoplasm. However, uncertain whether an histamine2‐receptor antagonist or proton‐pump inhibitor is more effective.

7142 Endoscopic hemoclipping for upper gastrointestinal bleeding due to mallory-weiss syndrome.

Aim: Endoscopic treatment with sclerotherapy or thermal methods has been widely used for upper gastrointestinal (UGI ) bleeding due to Mallory-Weiss syndrome (MWS). However, the potential drawback of thermal methods and the injection of sclerosing agents is that these may cause excessive tissue injury leading to necrosis and perforation. Recently, endoscopic hemoclipping was shown to be highly effective for as a hemostatic treatment for UGI bleeding. Hemoclipping causes less damage to the surrounding area than sclerotherapy or thermal methods. However, the efficacy and safety of hemoclipping for MWS bleeding has not been reported. The aim of the present study was to assess prospectively the usefulness of endoscopic hemoclipping for MWS bleeding. Methods: This prospective study was performed over a 5 year period beginning in January 1994. When patients were diagnosed with MWS by endoscopy , hemoclipping was performed for patients with active bleeding , visible vessel and/or red clots (Group H). The remaining patients with old clots and linear tears in the Esophagogastric junctional (EGJ) mucosa as the only possible origin of bleeding were conservatively treated (Group C). The clinical data and outcome of endoscopic treatment were compared between these two groups. Results: A total of 58 patients underwent emergency endoscopy for UGI bleeding due to MWS from January 1994 to August 1999. During endoscopic examination, active bleeding was found in 17 patients (29%), a visible vessel in one patient (2%) and red clots in 8 patients (14%); Hemoclipping was performed on all 26 patients. Of the remaining 32 patients, 12 patients (21%) had old clots, and 20 (34%) had linear tears without stigmata of recent hemorrhage in the EGJ; these patients did not receive hemoclipping. Significantly more patients in Group H had shock and trasfusional requirements over 800ml than in Group C [the former 4 (17%) vs 0, the latter 4 (17%) vs 0]. The mean hemoglobin level on admission was significantly lower in Group H (10.6±2.9g/dl)than in Group C (12.2±3.0g/dl). Significantly more patients in Group H had critical concomitant diseases than in Group C [14 (54%) vs 8 (25%)]. However, all patients in Group H successfully underwent endoscopic hemostasis with no rebleeding. No patients in Conservative group had rebleeding. No complications related to the endoscopic procedures and no hospital deaths were found in either group. Conclusion : Endoscopic hemoclipping provided an effective and safe modality for securing hemostasis for MWS bleeding.

NUDT15 codon 139 is the best pharmacogenetic marker for predicting thiopurine-induced severe adverse events in Japanese patients with inflammatory bowel disease: a multicenter study

BackgroundDespite NUDT15 variants showing significant association with thiopurine-induced adverse events (AEs) in Asians, it remains unclear which variants of NUDT15 or whether additional genetic variants should be tested to predict AEs. To clarify the best pharmacogenetic test to be used clinically, we performed association studies of NUDT15 variants and haplotypes with AEs, genome-wide association study (GWAS) to discover additional variants, and ROC analysis to select the model to predict severe AEs.MethodsOverall, 2630 patients with inflammatory bowel disease (IBD) were enrolled and genotyped for NUDT15 codon 139; 1291 patients were treated with thiopurines. diplotypes were analyzed in 970 patients, and GWASs of AEs were performed with 1221 patients using population-optimized genotyping array and imputation.ResultsWe confirmed the association of NUDT15 p.Arg139Cys with leukopenia and alopecia (p = 2.20E−63, 1.32E−69, OR = 6.59, 12.1, respectively), and found a novel association with digestive symptoms (p = 6.39E−04, OR = 1.89). Time to leukopenia was significantly shorter, and when leukopenia was diagnosed, thiopurine doses were significantly lower in Arg/Cys and Cys/Cys than in Arg/Arg. In GWASs, no additional variants were found to be associated with thiopurine-induced AEs. Despite strong correlation of leukopenia frequency with estimated enzyme activities based on the diplotypes (r2 = 0.926, p = 0.0087), there were no significant differences in the AUCs of diplotypes from those of codon 139 to predict severe AEs (AUC = 0.916, 0.921, for acute severe leukopenia, AUC = 0.990, 0.991, for severe alopecia, respectively).ConclusionsGenotyping of NUDT15 codon 139 was sufficient to predict acute severe leukopenia and alopecia in Japanese patients with IBD.

Evaluation of the drug-induced lymphocyte stimulation test for diagnosing mesalazine allergy

Background/Aims Mesalazine is an effective drug for treating ulcerative colitis (UC), but causes allergic symptoms in a few cases. Therefore, the objective of this study was to evaluate the usefulness of the drug-induced lymphocyte stimulation test (DLST) for the diagnosis of mesalazine allergy. Methods Patients with UC treated with mesalazine with or without a history of associated adverse events (AEs) were enrolled at Kyorin University Hospital from July 2016 to April 2017. Results The DLST was performed in 104 patients with UC, of which 24 had a history of AEs due to mesalazine treatment. The control value of DLST was 337.4±296.3 counts per minute (cpm) in the AE+ group and 408.0±371.9 cpm in the AE− group. The measured value of DLST was 578.8±424.7 cpm in the AE+ group and 476.5±471.8 cpm in the AE− group. The stimulation index (SI) was 243.9%±291.1% in the AE+ group and 119.8%±53.0% in the AE− group. The SI value and DLST positivity were significantly higher in the AE+ group than in the AE− group (P=0.030 and P=0.029, respectively). The test sensitivity and specificity were 0.240 and 0.805, respectively, and the false-positive and false-negative rate was 0.195 and 0.760, respectively. Conclusions The DLST for mesalazine showed low sensitivity and high specificity, suggesting that it may be useful for the definitive diagnosis of allergy to mesalazine.

An HIV-infected Patient with Confirmed Overlapping Complications of Severe Amebic Colitis and CMV Enteritis

We herein report a case of simultaneous amebic colitis and cytomegalovirus (CMV) enteritis in an HIV-infected patient. The patient was a 40-year-old man who developed bloody stool and diarrhea. We diagnosed him with severe amebic colitis associated with HIV infection and administered metronidazole. While his symptoms began to improve, the patient then developed CMV enteritis. We administered ganciclovir, and his symptoms improved. However, despite control of the infection, stenosis of the descending colon caused intestinal obstruction, and colostomy was performed. This case shows the importance of considering the possibility of simultaneous infection when gastrointestinal symptoms appear in people infected with HIV.