Mitsuru Seo

Association of Helicobacter pylori infection with atrophic gastritis and intestinal metaplasia.

Abstract Aims: To evaluate the effect of Helicobacter pylori infection and aging on atrophy and intestinal metaplasia of the gastric mucosa.

Evaluation of the clinical course of acute attacks in patients with ulcerative colitis through the use of an activity index.

Background. Because it is not easy to make a clinical decision regarding surgical treatment in patients with acute attacks of ulcerative colitis, an objective, simple, criterion is needed to determine the optimum timing for colectomy. The aim of this study was to retrospectively examine to what extent an activity index (AI) can evaluate the clinical course in such acute attacks. Methods. One hundred and twenty-seven patients with moderate or severe attacks of ulcerative colitis were examined. AI values and the decline in AI values were compared between surgical and nonsurgical groups after 1 week and 2 weeks of medical therapy. To evaluate the clinical course of acute attacks, cutoff AI values were set at every 10 points between values of 180 and 210. The positive predictive value for surgery was examined. Results. AI values in the surgical group were significantly higher than those in nonsurgical group at pretreatment, and after 1 or 2 weeks of medical therapy. The decline of AI values in the nonsurgical group was significantly higher than that in the surgical group after 1 or 2 weeks of medical therapy. At pretreatment, the prediction of colectomy was less than 50% at any of the cutoff values. After 1 week of therapy, approximately 60% of patients with an AI value greater than any of the cutoff AI values required colectomy. After 2 weeks of therapy, 30 of 43 (70%), 28 of 38 (74%), 24 of 29 (83%), and 17 of 21 (81%) patients with AI values greater than 180, 190, 200, and 210, respectively, required colectomy. Overall accuracy was 86%, 87%, 88%, and 83% for cutoff AI values of 180, 190, 200, and 210, respectively. Because the overall accuracy and positive predictive value for colectomy at AI values of 200 were significantly higher than these parameters at other AI values after 2 weeks of therapy, an AI value of 200 was regarded as the cutoff value most able to predict colectomy. Conclusions. We concluded that patients with an AI value in excess of 200 after 2 weeks of medical therapy would require surgical treatment.

A new quadruple therapy for Helicobacter pylori: influence of resistant strains on treatment outcome

: There have been no reports concerning the efficacy and safety of a 1‐week quadruple therapy regimen of omeprazole, amoxycillin, roxithromycin and metronidazole for Helicobacter pylori infections and the impact of primary resistance on the eradication rate.

A new quadruple therapy for the eradication of Helicobacter pylori. Effect of pretreatment with omeprazole on the cure rate.

Abstract: To elucidate whether pretreatment with omeprazole decreases the cure rate of Helicobacter pylori infection with a new quadruple therapy, and thus, whether this pretreatment should not be used in clinical practice, we conducted a randomized trial. Ninety patients with chronic peptic ulcer disease and nonulcer dyspepsia, with biopsy-proven H. pylori infection were randomly assigned to the two following regimens: Group 1 (n = 45) received omeprazole 20 mg once daily for 2 weeks (days 1–14), and 500 mg amoxicillin granules and 250 mg metronidazole thrice daily, and roxithromycin 150 mg twice daily for 1 week (days 8–14), Group 2 (n = 45) received the same antibiotic treatment as group 1 for 1 week (days 1–7), in addition to omeprazole treatment for 2 weeks (days 1–14). Four weeks after the treatment ended, endoscopy was repeated, with two biopsy specimens each taken from the antrum and the corpus (total of four specimens) for a urease test, histological analysis, and culture to establish cure of infection. A patient was regarded as cured only if all three methods gave negative results for H. pylori. In the intention-to-treat analysis, 42 of 45 patients (93.3%; 95% confidence intervals [CI], 81.7%–98.6%) in group 1 were cured compared with 43 of 45 patients (95.6%; 95% CI, 84.9%–99.5%) in group 2. In the per-protocol analysis, the corresponding figures were 42/44 (95.5%; 95% CI 84.5%–99.4%) and 43/44 (97.7%; 95% CI, 88.0%–99.9%). There were no significant differences in the cure rate between the two groups on either analysis. All patients, except for one who had an allergic reaction, completed the treatment regimens. Fifty to sixty percent of the patients had no side effects while the rest had mild to moderate side effects. The new quadruple therapy consisting of omeprazole, amoxicillin, metronidazole, and roxithromycin appears suitable for use in clinical practice, as the cure rate was 95% and no severe side effects were observed. Pretreatment with omeprazole did not reduce the cure rate for this new quadruple therapy.

Correlation between endoscopic severity and the clinical activity index in ulcerative colitis.

Correlation between endoscopic severity and the clinical activity index in ulcerative colitis

The role of total parenteral nutrition in the management of patients with acute attacks of inflammatory bowel disease.

The aim of this study was to evaluate the effects of the prolonged duration of total parenteral nutrition (TPN) on the clinical, laboratory, and nutritional parameters and short-term outcome in acute attacks of ulcerative colitis and Crohns colitis, and the difference in the response to TPN between the two diseases. Twenty-two patients with severely and moderately active ulcerative colitis (8 severe and 14 moderate) and 12 patients with Crohns colitis were analyzed retrospectively. Eleven of 22 patients with ulcerative colitis were treated with TPN and corticosteroids (TPN group). The remaining 11 patients were treated with corticosteroids alone and hospital meals (oral diet group). Both groups were matched regarding disease severity at pretreatment. The clinical characteristics, and the initial and total dosages of corticosteroids for 3 weeks were similar between the two groups. The authors compared the changes in the clinical, inflammatory, and nutritional parameters and short-term outcome between the TPN and the oral diet groups with ulcerative colitis. The same evaluations were also made for 12 patients with Crohns colitis who received TPN (CD group). The TPN group did not show any significant improvement in the clinical parameter, inflammatory signs, or nutritional state compared with the oral diet group with ulcerative colitis. The remission rate after 3 weeks of therapy and a colectomy rate also showed no significant difference between the two groups. In contrast, TPN resulted in a disappearance of clinical symptoms and an improvement in both the inflammatory and nutritional parameters in the CD group. Only one of the 12 patients with Crohns colitis underwent colectomy. TPN induced no additional benefit in corticosteroid therapy in an acute attack of ulcerative colitis. In contrast, TPN may have primary effects on Crohns colitis.

Long pedunculated colonic polyp composed of mucosa and submucosa: proposal of a new entity, colonic muco-submucosal elongated polyp.

We encountered 15 patients with colonic polyps showing histologic features that did not belong to any of the known categories. All polyps were elongated and drumstickshaped, with lengths of 12 to 160 (mean, 29 mm) mm. Histologically, the polyps were covered with normal mucosa and consisted of edematous, loose, fibrous, connective tissues and dense, fibrous submucosal layers, often showing dilation of blood vessels and lymphatics. Although the mechanism of generation of such polyps remains unknown, their elongation may be caused by intestinal motion. Because this kind of polyp has not been described previously outside Japan, we here introduce a new type of polyp, which we have proposed calling the colonic muco-submucosal elongated polyp.

Recurrence of Helicobacter pylori infection and the long-term outcome of peptic ulcer after successful eradication in Japan.

&NA; Recurrence of peptic ulcer after successful eradication of Helicobacter pylori is closely associated with reinfection. The aim of this study was to examine the recurrence of peptic ulcer and reinfection with H. pylori after successful eradication. To eradicate H. pylori infection, patients with active peptic ulcer disease were assigned to two treatment groups depending on the year of their enrollment (AM group and OAMR group). Patients in the AM group received 400 mg of cimetidine twice per day, 300 mg of amoxicillin three times per day, and 250 mg of metronidazole three times per day for 2 weeks. Patients in the OAMR group received 20 mg of omeprazole once per day, 500 mg of amoxicillin granules three times per day, 250 mg of metronidazole three times per day, and 150 mg of roxithromycin twice per day for 1 week. After endoscopy verified ulcer scarring and successful eradication of H. pylori infection, study patients were followed up monthly and did not undergo acid‐suppressive therapy. Endoscopy was performed at 6‐month intervals for the 1st year. After the 1st year, follow‐up endoscopies were performed annually. In total, 107 patients with peptic ulcer (duodenal ulcer [DU], 65; gastric ulcer [GU], 42) were followed up for a mean period of approximately 2 years. Recurrence of infection occurred in 10 (9.3%) of 107 patients (AM group, 9; OAMR group, 1) after 210 patient‐years of follow‐up; the recurrence rate was 4.8% per patient‐year. Recurrence of H. pylori infection was significantly higher in the AM group (23.1%) than in the OAMR group (1.5%). H. pylori infection recurred in two patients 6 months after eradication therapy, in seven 1 year after, and in one 2 years after. Thereafter, no further cases of H. pylori recurrence were observed. During follow‐up periods, seven cases of ulcer recurrence were observed (DU, 4; GU, 3). The rate of peptic ulcer recurrence within 2 years after eradication therapy was significantly higher than that after more than 2 years. Four cases of ulcer recurrence (DU, 3; GU, 1) also had recurrence of H. pylori infection. One recurrent case of DU without reinfection was associated with nonsteroidal anti‐inflammatory drugs. The remaining two cases of GU recurred without H. pylori reinfection. In conclusion, peptic ulcer recurrence rarely occurred (3 [2.9%] of 103) in patients cured of H. pylori infection. Reinfection after apparent successful eradication was rarely noted when a powerful therapeutic regimen in eradication was used. Therefore, to eradicate H. pylori, a highly effective therapeutic regimen should always be used.

Metastatic Breast Carcinoma Simulating Linitis Plastica of the Colon : Report of a Case

A 48-year-old woman developed a mobile abdominal mass in the course of treatment for recurrent breast cancer. Imaging studies indicated linitis plastica of the colon. She underwent surgery because of the stenosis of the transverse colon. An examination of the resected specimen revealed a segmental stricture, thickening of the entire wall, and a granular mucosa resembling cobblestones. Microscopic findings of the colon lesion were very similar to those of her primary, invasive lobular carcinoma of the breast. Atypical cells showed immunoreactivity for cytokeratin-7, but not for cytokeratin-20. These findings suggested that the lesion of the colon was a colonic metastasis of breast cancer. Metastatic gastrointestinal diseases originating from breast carcinoma are unusual, and colonic metastases are especially rare. Although colon cancer may occur in patients with a history of breast cancer, metastatic colon cancer should be suspected if linitis plastica is detected.

Portal vein thrombosis successfully treated with a colectomy in active ulcerative colitis

Portal vein thrombosis is a rare complication in ulcerative colitis. We present a patient with portal vein thrombosis in ulcerative colitis who was successfully treated with colectomy. A 38-year-old Japanese female was admitted to our hospital because of an exacerbation of colitis. Abdominal ultrasonography performed because of liver dysfunction showed the thrombus in an umbilical portion of the portal vein. The patient underwent a subtotal colectomy and ileostomy because her colitis did not respond to intensive intravenous therapy. Although portal vein thrombus was treated with an intravenous infusion of urokinase before the operation, no change in the thrombus size was found. Approximately three months after the colectomy, the thrombus of the portal vein disappeared without anticoagulant therapy. Although a resection of an inflamed colon may be theoretically effective in the thrombosis in the inflammatory bowel disease, its benefit has not been confirmed. Our case suggests that the resection of the diseased bowel may have a favorable effect on the course of portal vein thrombosis in acute attacks of ulcerative colitis.