Nozomi Takeuchi

Evaluation of Gastric Motor Activity in the Elderly by Electrogastrography and the 13C-Acetate Breath Test

Background: Elderly people frequently have symptoms of fullness and appetite loss due to impaired gastric motor activity. These symptoms may cause malnutrition, immunosuppression and other complications. Objective: The effects of aging and daily activity on gastric motility in the elderly were investigated by electrogastrography and the 13C-acetate breath test. Methods: We enrolled seven active elderly subjects (active elderly group), seven elderly subjects staying at a geriatric facility who had reduced mental and physical capacities (inactive elderly group) and seven healthy young volunteers (young group). Electrogastrography was recorded before and after ingestion of a 13C-acetate-mixed liquid meal. Expired air was sampled every 10 min after the meal to measure the 13CO2 concentration. Results: The ratio of the incidence of the 3-cpm wave (gastric intrinsic frequency) during the postprandial period compared to the fasting state was reduced in both elderly groups compared to young subjects, and the reduction was greater in the inactive elderly than in the active elderly group. The ratio of the amplitude of the peak frequency during the postprandial period to that in the fasting state (power ratio) was also lower in the elderly groups. The time of peak 13CO2 expiration was delayed in the active elderly and more so in the inactive elderly group. Conclusion: Postprandial peristalsis and gastric contractile force are reduced in the elderly, and gastric emptying is delayed indicating a reduction in gastric motor activity.

Utility and problems of endoscopic submucosal dissection for early gastric cancer in elderly patients.

Background and Aim:  Endoscopic submucosal dissection (ESD) is reported to be a safe and reliable procedure for the elderly, but these reports could have already had a bias at the time ESD was performed. However, the reports have not clearly stated the criteria of indications. In the present study, we retrospectively elucidated the usefulness and problems of ESD for early gastric cancer in elderly patients (≥ 65 years) in comparison with non‐elderly patients.

Risk Management for Gastrointestinal Endoscopy in Elderly Patients: Questionnaire for Patients Undergoing Gastrointestinal Endoscopy

More elderly patients now undergo gastrointestinal endoscopy following recent advances in endoscopic techniques. In this study, we conducted a high-risk survey of endoscopies in Japan, using a questionnaire administered prior to upper gastrointestinal tract endoscopy (UGITE), and identified anticholinergic agents and glucagon preparations as high-risk premedication. We also evaluated the cardiovascular effects of anticholinergic agents and glucagon through measurements of plasma levels of human atrial natriuretic peptide (hANP) and human brain natriuretic peptide (hBNP). The subjects were 1480 patients who underwent UGITE. Nurses administered a pre-endoscopy questionnaire, questioning subjects regarding heart disease, hypertension, glaucoma, and urinary difficulties as risk factors for anticholinergic agents, and Diabetes mellitus as a risk factor for glucagon preparations. Evaluation of subjects divided into under 65 and over 65 age groups revealed that in subjects aged 65 and over, risk factors for anticholinergic agents were significantly more high than those for glucagon. Analysis of the cardiovascular effects of anticholinergic agents and glucagon, in the elderly patients showed that hANP levels were significantly higher following administration of anticholinergic agents, but the change was not significant for glucagon premedication. Taking a detailed history before UGITE with the aid of a questionnaire at the same time as informed consent is obtained, is extremely useful in terms of risk management and selection of the appropriate premedication.

Gastric ulcer healing after treatment of endoscopic submucosal dissection in Japanese: comparison of H2 receptor antagonist and proton pump inhibitor administration

Endoscopic submucosal dissection has made it possible to resect large lesions during a single operation. The present study was undertaken to compare the time taken for recovery from artificial ulcers after endoscopic submucosal dissection between an H2 Receptor Antagonist treatment group and a Proton Pump Inhibitor treatment group, focusing on analysis of the time course of reduction rate in ulcer area. The powerful acid suppression by Proton Pump Inhibitor may not be needed to treat Japanese post-endoscopic submucosal dissection ulcer which usually develops after early gastric carcinoma in the mucosa of low acid secretory capacity. The study involved 60 patients with 69 artificial ulcers following endoscopic submucosal dissection for the treatment of tumors remaining in the gastric mucosa. Of all lesions, 36 were allocated to the H2 Receptor Antagonist group and 33 to the Proton Pump Inhibitor group. Patients in both groups underwent endoscopy at 4 and 8 weeks after the start of administration. There were no significant differences between two groups and ulcer healing rates were similar in the two groups. The efficacy of H2 Receptor Antagonists in curing this type of ulcer can thus be expected to be comparable to that of Proton Pump Inhibitors.

Strategies for peptic ulcer healing after 1 week proton pump inhibitor-based triple Helicobacter pylori eradication therapy in Japanese patients: differences of gastric ulcers and duodenal ulcers.

Helicobacter pylori (H. pylori) eradication therapy alone is insufficient to ensure healing of large ulcers with H. pylori-positive gastric ulcer (GU). The question of what is the optimum antiulcer treatment following H. pylori eradication therapy has not been fully elucidated. Furthermore, the ulcer healing effects of eradication therapy itself with H. pylori-positive duodenal ulcer (DU) have not been investigated. In GU study, the eradication therapy + proton pump inhibitor (PPI) group (group A) were administered eradication therapy followed by 7 weeks of a PPI, and the eradication therapy + gastroprotective drug (GP) group (group B) eradication therapy followed by 7 weeks of a GP. In DU study, the eradication therapy + PPI group (group C) were administered eradication therapy followed by 5 weeks of a PPI, and the eradication therapy only group (group D) was eradication therapy alone. In GU study, healing rates for ulcer of ≥15 mm in diameter were significant greater in the group A. In DU study, high healing rates were seen both the group C and D. In conclusion, a PPI could significantly heal GU than a GP after eradication therapy in GU. Meanwhile, the eradication alone is sufficient for DU.

Characteristics of refractory gastroesophageal reflux disease (GERD) symptoms -is switching proton pump inhibitors based on the patient's CYP2C19 genotype an effective management strategy?

OBJECTIVE We investigated factors related to proton pump inhibitor (PPI) -refractory gastroesophageal reflux disease (GERD) symptoms, particularly with respect to acid, the CYP2C19 genotype and psychological aspects. METHODS Patients with an Frequency Scale for the Symptoms of GERD (FSSG) score of ≥8 after the initial treatment were switched to therapy with rabeprazole at a dose of 20 mg once daily for eight weeks. We investigated the rate of improvement in PPI-refractory GERD symptoms, background factors, the Hospital Anxiety and Depression Scale (HADS) score and the CYP2C19 genotype. Patients Sixty patients endoscopically diagnosed with reflux esophagitis within the past six months who had received omeprazole at a dose of 20 mg once daily for eight weeks or longer were enrolled. RESULTS In 71.6% of the patients, the FSSG score decreased to <8 after treatment with omeprazole at a dose of 20 mg once daily for ≥8 weeks, resulting in improvements in their GERD symptoms. Significant factors related to omeprazole-refractory GERD symptoms included a longer disease duration (p=0.0004) and higher HADS score (p=0.01). Among the omeprazole-refractory cases, only 23.5% of the patients showed symptom improvement after switching to rabeprazole. There were no significant differences in the average scores for FSSG (p=0.089) or HADS (p=0.182), before or after the drug change. A total of 92% of the rabeprazole poor responders were homo/hetero extensive metabolizers for the CYP2C19 genotype. CONCLUSION Our findings suggest that switching the PPI from omeprazole (20 mg once daily) to rabeprazole (20 mg once daily) is not a significant effective therapeutic strategy for improving PPI-refractory GERD symptoms, taking into consideration possible psychometric factors and patients who require stronger acid suppression than that achieved with a double dose of PPIs for PPI-refractory GERD symptoms.

S1614 Effects of Helicobacter pylori Infection On Mucin Phenotype of Early Differentiated Gastric Carcinoma; Study with Gastric Mucosal Specimens Obtained By Endoscopic Mucosal Resection

thione and lipid peroxidation (LPO) in the frozen gastric mucosa were determined. Results: Gastric mucosal atrophy was observed by giving 0.1% ammonia water ad libitum for 6 weeks. The course of atrophy was similar to that of human atrophic gastritis due toHelicobacter pylori infection. Furthermore, both superficial and deep mucus significantly decreased. On the contrary, coadministration of GGA, one of gastric mucosal protective agents, inhibited decrease in gastric mucus as well as gastric mucosal atrophy in the 0.1% ammonia water group. In that way, MPO activity, which is an index of tissue disorders in gastric mucosa, and LPO activities were significantly increased due to access to ammonia water, while GGA suppressed these activities. Conclusion: It was suggested that significant elevations in MPO and LPO activities were associated with gastric mucosal atrophy induced by long-term administration of ammonia water, and that the anti-ulcer agent geranylgeranylacetone preserved the intra-gastric mucous quantity while inhibiting the gastric mucosal atrophy without the elevations in MPO and LPO activities.

Endoscopic Submucosal Dissection Techniques for Early Gastric Cancer

Endoscopic Submucosal Dissection Techniques for Early Gastric Cancer Eiji Umegaki, Satoshi Tokioka, Masaya Tanaka, Nozomi Takeuchi, Chikako Eiraku, Takao Noguchi, Minekazu Ozawa, Toshihisa Takeuchi, Nanako Shiraishi, Keishi Kojima, Ichiro Hirata, Ken-ichi Katsu Although the strip biopsy method is popular endoscopic mucosal resection technique (EMR) for its convenience and reliability, it has limitations in resectable tumor size. Endoscopic submucosal dissection techniques (ESD) using the diathermic needle knife or the insurated-tip diathermic knife have been introduced to overcome this disadvantage, but they have high risks for bleeding and perforation. Our intent in this study was to investigate the usefulness of ESD for early gastric cancer comparison with the strip biopsy method and the educational system in our hospital. Materials and Methods: Studies were carried out on 505 lesions in whom EMR was performed, 385 lesions were treated with the strip biopsy and 120 with ESD. We investigated the en-bloc resection rate, the complication rate of bleeding and perforation, and the learning curve of ESD in our hospital. Results: (1) The en-bloc resection rate of the strip biopsy method was 54.8% and that of ESD was 87.4%. (2) Irrespective of tumor size and location, we could resect the tumor with a much higher en-bock resection rate. (3) The complication rate of bleeding and perforation was 0.7% in the strip biopsy method and 8.7% in ESD. (4) Training for ESD was acquired in an informal setting (observation of actual procedures by videotapes, animal models) and a formal setting. Nothing can replace live demonstrations of ESD. (5) The learning curve of ESD in our hospital. Conclusion: Endoscopists who seek to perform ESD should avail themselves of training and education in a formal or informal setting. ESD is promising as a safe and reliable technique for the treatment of early gastric cancer. T1402 Endoscopic Gastroenteric Anastomoses with Magnets (EGAM): Three Years After Augusto Villaverde, Constantine Cope, Nestor Chopita, Nestor Landoni, Alberto Bernedo, Horacio Martinez, Alejandro Jmelnitzky Introduction: Three years ago we presented a novel technique of gastroenteric anastomoses, formed by endoscopic magnet assisted nonsurgical technique as an alternative to enteral stents(SEMS) and surgery for malignancies involving the duodenum or gastric antrum. Aims & Methods: The purpose of this study is to evaluate three years of work with this technique and evaluate early and late complication rates. Patients: From December 2001 until November 2004, 21 patients with malignant biliary, gastric and duodenal obstruction were included in the study. All patients were deemed non-surgical candidates because of their advanced disease and poor performance status, according to AJCC classification. Methods: All patients had biliary drainage performed prior to EGAM either by ERC or PTC. Once the EGAM was completed, the patients were included in a monthly follow-up protocol with endoscopy, radiology, evaluation of symptoms, nutritional status, and the Karnoftsky rating scale. Results: The procedure was successful in 19 of 21 patients. All patients started with oral intake after one day of the procedure and were hospitalized for two days. Early complications was perforation of immature fistula in two patients. During the follow-up, 3 stent migrations and 1 obstruction of the stent by solid food, were presented. Ten patients maintained their baseline Karnofsky score, two patients increased this by one point and 1 patient increased this score by 2 points and is still alive. All patients had good patency of the anastomoses until their time of death. The mean survival was 4.3 months. Conclusion: Our results demonstrate the safety and efficacy of EGAM as a novel, non-surgical option for creating a gastroenteric anastomosis in human beings. We believe this minimally invasive technique is a valid alternative to SEMS with good results in long term follow up. More trials are necessary to confirm our findings.