Tadahisa Ebato

Gastroduodenal Mucosal Injury in Patients Taking Low-Dose Aspirin and the Role of Gastric Mucoprotective Drugs: Possible Effect of Rebamipide

The present study was conducted to investigate the prevalence of mucosal injury in patients taking low-dose aspirin in Japan and examine the effect of gastric mucoprotective drugs on aspirin-related gastroduodenal toxicity. We selected 530 patients who had taken low-dose aspirin for 1 month or more after undergoing esophagogastroduodenoscopy from 2005 through 2006 at Teikyo University Hospital, Tokyo, Japan. Endoscopic records were retrospectively reviewed to determine the presence of massive bleeding and mucosal injury (ulcer or erosion). The influence of clinical factors, including co-administration of gastroprotective drugs, was also examined. Hemorrhage was observed in 25 patients (3.7%) and mucosal injury (36.2%) in 192 patients. The presence of Helicobacter pylori antibody was a significant risk factor associated with mucosal injury. Patients taking any gastroprotective drug showed a significantly lower rate of mucosal injury than those not taking these drugs. Patients taking rebamipide concomitantly with proton pump inhibitors or histamine 2 receptor antagonists had mucosal injury less frequently than those taking acid suppressants plus other mucoprotective drugs. In conclusion, these results show the possible gastroprotective effects of rebamipide, suggesting that it may be a good choice in aspirin users with gastroduodenal toxicity that is not suppressed by acid suppressants alone.

Prevalence of erosive esophagitis among Japanese patients taking low-dose aspirin.

Background and Aim:  The risk for erosive esophagitis (EE) with low‐dose aspirin (ASA) remains unknown, especially among Japanese patients. We conducted the present study to compare the risk of EE with that of gastroduodenal mucosal injury among Japanese patients taking ASA.

A Pancreatic Mass Lesion

Department of Internal Medicine, and Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 Question: A 61-year-old woman with a 3-month history of general fatigue was referred to our hospital for detailed assessment of jaundice. Blood findings were as follows: total bilirubin, 7.47 mg/dL; aspartate aminotransferase, 164 U/L; alanine aminotransferase, 275 U/L; lactate dehydrogenase, 270 U/L; and alkaline phosphatase, 2302 U/L without elevated tumor markers. Dynamic computed tomography (CT) revealed a heterogeneous enhanced mass in the pancreatic head with a diameter of 40 mm and a smooth margin (Figure A). Distant metastasis and lymph node swelling were undetectable. T1and T2-weighted magnetic resonance imaging (MRI) revealed a tumor with hypointense and hyperintense areas, respectively (Figures B, C). MR cholangiopancreatography showed tumor compression of the common bile duct, an obviously dilated biliary tract, and that the pancreatic duct was not dilated and did not communicate with the tumor (Figure D). Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (FDG-PET/ CT) revealed FDG accumulation in the tumor with a max standardized uptake volume of 5.87 (Figure E). Drainage using a biliary stent was followed by surgical resection. The tumor was surrounded by a fibrous capsule and included a cystic, hemorrhagic area (Figure F). What is the diagnosis?

Differences in Clinical Characteristics between Right- and Left-Sided Colonic Diverticular Hemorrhage

Background: The number of patients with diverticular diseases has recently increased in Japan. Hemorrhage is a common manifestation of colonic diverticulosis, and the most frequent cause of lower gastrointestinal bleeding. Right- (RSD) and left- (LSD) sided diverticula are more predominant in Asian and in non-Asian populations, respectively. This retrospective study investigates differences in the clinical courses of hemorrhages arising from RSD and LSD. Methods: The clinical characteristics of 109 consecutive patients with colonic diverticular hemorrhage (from RSD, n=75; from LSD, n=34) selected from those admitted to Teikyo University Hospital (Tokyo, Japan) between January 2004 and August 2012 were compared. Results: Mean age was slightly lower and males were more predominant in the RSD than in the LSD group. All other background data were similar. Four and two patients in the RSD group required surgical resection and hemostasis using angiography, respectively, whereas none of the patients in the LSD group needed such invasive treatment. Endoscopic hemostasis was achieved in 21 (28%) of 75 and in 5 (14.7%) of 34 patients in the RSD and LSD groups, respectively, although the difference was not significant. The recurrence rates were essentially identical (RSD, 17.3%; LSD, 17.6%). Conclusion: Patients with hemorrhage from RSD tended to be more male-dominant than those from LSD. Serious bleeding is more likely to arise in patients with RSD, and endoscopic hemostasis is one choice of treatment when bleeding is suspected.