Mitsuhiko Kubo

Randomized comparative study of omeprazole and famotidine in reflux esophagitis.

Background: Although proton pump inhibitors (PPI) and H2‐receptor antagonists (H2‐RA) are routinely used in the treatment of reflux esophagitis (RE), no consensus has been reached yet as to whether the first‐choice drug should be PPI or H2‐RA. In this study, the effects of omeprazole (OMP) and famotidine (FAM) on RE have been examined in a randomized comparative study.

Roles of double-balloon endoscopy in the diagnosis and treatment of Crohn’s disease: a multicenter experience

BackgroundDouble-balloon endoscopy (DBE) examinations are not yet widely accepted as routine procedures for examining the small bowel of patients with Crohn’s disease (CD).AimTo evaluate the feasibility and usefulness of DBE for CD in tertiary-care hospitals.MethodsBetween July 2004 and September 2008, 1444 DBE procedures were performed for 704 patients in 6 tertiary-care hospitals. Patient profile, indication, diagnosis and treatment of DBE were evaluated using a multicenter database.ResultsDBE examinations were most frequently performed in 75 patients with CD, corresponding to 10.5% of all the patients examined by DBE. Fifty patients were diagnosed with CD before DBE, while DBE was performed for the diagnosis of 25 new CD patients. Small bowel lesions were often detected even when the terminal ileum was not involved. In the 75 patients, 21 patients were asymptomatic at the time of DBE examinations. Active inflammatory lesions were detected in 51.2% of the CD patients, and were even detected in 33.3% of the asymptomatic CD patients. The treatment was altered in 53.3% of the CD patients after the DBE evaluation. No severe complications were experienced.ConclusionsDBE procedures can be safely performed in patients with CD and should be considered for the precise evaluation of and to determine the treatment strategy for CD.

Effects of endoscopic variceal sclerotherapy using GT XIII on blood coagulation tests and the renal kallikrein-kinin system

SummaryForty-six sclerotherapy sessions were performed on liver cirrhotics with high-risk esophageal varices using GT XIII, a sclerosant composed of gelatin, thrombin and coagulation factor XIII. GT XIII was effective for the prevention of temporary symptoms and transient hypotension observed in 55 sclerotherapy sessions using thrombin. In 42 (91%) sessions, patients underwent sclerotherapy with no symptoms, and in the other four (9%) sessions, only slight symptoms of general fatigue and headache were observed. Changes in the mean arterial pressure were significantly smaller in sessions using GT XIII than in those using thrombin (-12.3± 13.6 vs. -26.8±20.7 mmHg, P<0.01). Changes in coagulation tests, similar to those of disseminated intravascular coagulation (DIC), were also reduced in sessions using GT XIII. Urinary kallikrein and kinin excretion significantly increased after the procedure (P<0.01), indicating activation of the renal kallikrein-kinin system. Increases in urinary kallikrein and kinin excretion showed a significant relationship with the consumed plasma fibrinogen levels (r = -0.51, P<0.01 and r= -0.58, P<0.01, respectively), and it was suggested that activation of the glandular kallikrein-kinin system caused by abrupt DIC-like changes in the hemostatic system might play a role in manifestations of temporary complications occurring with the use of hemostatic agents containing thrombin.

SUCCESSFUL ENDOSCOPIC HEMOSTASIS OF RECTAL DIEULAFOY's ULCER BY CLIPPING: AGING MAY BE A FACTOR

Dieulafoys ulcer is a rare form of gastrointestinal bleeding. Although the original descriptions and early reports were of lesions in the proximal stomach, similar lesions have subsequently been reported in the esophagus, duodenum, jejunum, colon and rectum. A 55‐year‐old man was admitted to hospital for a sudden acute headache. On admission he was conscious, and had severe occipitalgia due to a subarachnoid hemorrhage demonstrated on computed tomography. On the fifteenth hospitalization day, he passed fresh blood together with stool, followed by several further episodes of massive hematochezia. Although no lesion was found by gastroduodenoscopy, colonoscopy revealed fresh blood and clots in the rectum. No obvious source of hemorrhage could be identified until careful irrigation revealed pulsatile bleeding from a protuberant vessel (2 mm in size) in the rectum 5 cm from the anal verge. The patient underwent an endoscopic hemostasis in which the pulsatile vessel was easily sutured with seven clips. The patient did not have another episode of bleeding. The finding of Dieulafoys ulcer in the elderly‐patient group suggests that sclerotic changes to the artery may be associated with this type of rectal ulcer.