Naoharu Hamamoto

A new water instillation method for colonoscopy without sedation as performed by endoscopists-in-training

BACKGROUND Colonoscopy may be associated with discomfort when performed without sedation. A study was conducted to determine whether instillation of water into the colon at the beginning of the procedure reduces intubation time as well as patient discomfort and pain. METHODS Colonoscopy was performed in 259 patients by 3 endoscopists-in-training with limited experience. Patients were randomly allocated to 2 groups. In one, a technique was used in which 500 to 1000 mL of water is instilled into the colon by enema at the beginning of the procedure (instillation group, n = 130). In the other, patients underwent a conventional colonoscopy (control group, n = 129). Intubation time was measured and compared between the groups, and subjective discomfort experienced by the patients was measured upon completion of the examination. RESULTS Success rates for insertion to the cecum were similar, (95.4%, instillation group; 96.1%, control group). Detection rates for any colorectal diseases were not different between the groups (30.0% vs. 32.6%). Mean time to cecal intubation was 10.5 minutes in the instillation group and 16.2 minutes in the control group (p < 0.0001). The proportion of patients who complained of abdominal pain during the procedure was 17.1% in the instillation group and 33.3% in the control group (p < 0.001). CONCLUSIONS When used by endoscopists-in-training, the water-instillation colonoscopy technique was associated with less discomfort and faster cecal intubation with no decrease in the rate of detection of colorectal diseases.

Symptom relief in patients with reflux esophagitis: Comparative study of omeprazole, lansoprazole, and rabeprazole

Background and Aim:  Rabeprazole has a faster onset of antisecretory activity than omeprazole and lansoprazole. The aim of the present study was to clarify whether there is any difference in the speed of symptom relief in patients with reflux esophagitis following the administration of these three proton pump inhibitors (PPI).

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.

Diarrhea Caused by Proton Pump Inhibitor Administration: Comparisons Among Lansoprazole, Rabeprazole, and Omeprazole

BACKGROUND The number of patients who require treatment with proton pump inhibitors (PPIs) is increasing in Japan. One of their adverse effects is diarrhea. OBJECTIVES We investigated the incidence of diarrhea caused by 3 different PPIs: lansoprazole, rabeprazole, and omeprazole. METHODS Patients using PPIs for >1 month were enrolled. Enrolled patients recorded daily stool frequency, stool consistency using the Bristol Stool Scale Form, and impaired quality of life caused by diarrhea for 1 month. Their attending physicians described the types and dosages, and duration of PPI administration, as well as other necessary information. RESULTS A total of 255 patients participated. Mean age of the patients was 70.7 years old. During the 1-month observation period, 3.5% of the patients complained of diarrhea. There was no significant difference for the incidence of diarrhea among the 3 types of PPIs. Furthermore, no correlations between diarrhea and length and dosage of PPI administration were found. CONCLUSIONS The incidence of diarrhea in patients receiving long-term therapy did not differ among 3 different PPIs. ClinicalTrials.gov identifier: UMIN ID 000005300.

Comparative study of nizatidine and famotidine for maintenance therapy of erosive esophagitis

Background:  The therapeutic effect of combined administration of prokinetics and histamine H2 receptor antagonists (H2RA) in gastroesophageal reflux disease is reported to be superior to that of monotherapy with H2RA alone. In addition to its acid‐suppressing effect, the H2RA nizatidine also has a prokinetic action by suppressing acetylcholine esterase. The present multicenter, randomized controlled study was performed to investigate whether nizatidine is superior to famotidine, which does not suppress acetylcholine esterase activity, in maintenance therapy for erosive esophagitis. In addition, the question as to whether the grade of erosive esophagitis affects the non‐recurrence rate during the maintenance therapy with H2RA was also investigated.

Morphological changes of pancreatic ducts in Otsuka Long-evans Tokushima Fatty rats.

Objective: To determine if pancreatic ductal changes characteristic of chronic pancreatitis occur in male Otsuka Long-Evans Tokushima Fatty (OLETF) rats and to elucidate the 3-dimensional structure of the pancreatic ducts in those rats. Methods: Male OLETF rats aged 10, 20, and 40 weeks were used. The pancreas was injected with a 120% barium sulfate suspension into the pancreatic ducts, after which radiograph images of the injected pancreas were taken using radiography of the soft parts. Conventional fixed pancreatic tissues were observed by the use of light and scanning electron microscopy, whereas corrosion casts of the pancreatic ducts were observed by the use of scanning electron microscopy. Results: In 20- and 40-week-old male OLETF rats, deletion of acini and formation of tubular complexes and tortuous or helical, deformed, dilated pancreatic ducts were found, whereas the inner surfaces of pancreatic ducts had many craterlike depressions and long cilia. Conclusions: Male OLETF rats demonstrated the same morphological changes in pancreatic ductal lumina and histological changes in pancreatic tissues as the rats were subjected to pancreatic duct ligation. These results suggested that increased pancreatic duct pressure occurs in male OLETF rats and induces the chronic pancreatitis-like lesions, including the above-mentioned findings.

Scanning Electron Microscope Examination of Pancreatic Ducts in Stroke-Prone Spontaneously Hypertensive Rats (SHRSP)

SummaryConclusionIschemic injury to the pancreatic ductal cells causes stasis of pancreatic juice, which in turn induces chronic pancreatitis.BackgroundThe pathogenesis of chronic ischemic pancreatitis is still unclear.MethodsIn 12-, 24-, and 36-wk-old, male stroke-prone spontaneously hypertensive rats (SHRSP), which have sclerotic arterioles with a marked narrowing lumen in the pancreas, pancreatic tissue was examined using light and scanning electron microscopy. Corrosion casts of pancreatic ducts and blood vessels were examined using scanning electron microscopy.ResultsDuctular proliferation, tortuous ductal channels, crater-like depressions of ductal inner surfaces, and long cilia of ductal cells were found to be sporadically distributed throughout the pancreatic tissue. Similar pancreatic abnormalities had been found in previous studies using WBN/Kob rats that exhibited pancreatic juice stasis. A few interlobular ducts in the pancreatic tissue of the SHRSP had an inner surface that was gyrus-like in appearance, a feature not found in WBN/Kob rats.

Effects of Omeprazole on Sleep Disturbance: Randomized Multicenter Double-Blind Placebo-Controlled Trial

Objectives:Gastroesophageal reflux is considered to cause sleep disturbance, whereas proton pump inhibitor (PPI) administration is reported to improve insomnia associated with gastroesophageal reflux disease (GERD). The majority of patients with gastroesophageal reflux are asymptomatic and a significant number with erosive esophagitis are also reported to be asymptomatic. We examined whether PPI administration has a therapeutic effect for improving insomnia in patients without reflux symptoms in the same manner as patients with reflux symptoms.Methods:We performed a randomized multicenter double-blind placebo-controlled trial using 176 patients with insomnia regardless of the presence of reflux symptoms. The patients were divided into those administered omeprazole (20 mg) or a placebo for 14 days. Four self-reporting questionnaires, QOLRAD-J (Japanese translation of Quality of Life in Reflux and Dyspepsia), Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and a sleep diary, were used for evaluating GERD-related quality of life (QOL) and sleep disturbance.Results:We evaluated 171 patients with insomnia, of whom 69 had typical reflux symptoms. Omeprazole statistically significantly improved GERD-related QOL from 30.8±0.7 to 33.0±0.5 (P<0.01) (QOLRAD-J, total) and from 6.0±0.2 to 6.6±0.1 (P<0.01) (QOLRAD-J, sleep-related) when administrated to patients with reflux symptoms. Omeprazole also improved insomnia significantly better than the placebo in patients with reflux symptoms; PSQI, from 9.3±0.5 to 7.9±0.5 (P<0.01) and sleep diary, from 2.1±0.1 to 1.8±0.1 (P<0.01). On the other hand, the therapeutic effects of omeprazole and the placebo were not different in patients without reflux symptoms.Conclusions:Our results showed that PPI administration is effective only for insomnia in patients with reflux symptoms.

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

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.

Primary sclerosing pancreatitis and cholangitis

Conclusion The clinical course of our patient suggests the association between chronic pancreatitis and primary sclerosing cholangitis (PSC), as well as the usefulness of prednisolone for the treatment of this condition.