Takahiko Kudo

Diversity of mucosa-associated microbiota in active and inactive ulcerative colitis

Objective. Recent findings indicate that bacteria play an important role in the pathogenesis of inflammatory bowel disease (IBD). However, the exact role of bacteria in ulcerative colitis (UC) has still to be elucidated. The objective of the study was to investigate the potential differences in the intestinal microbiota between patients with UC and control subjects, using terminal restriction fragment length polymorphism (T-RFLP) analysis of the mucosa-associated microbiota from UC patients and non-IBD controls. Material and methods. Nine active UC patients and 11 non-IBD controls were included in the study. Seven patients with active UC who entered into the inactive phase after antibiotic combination treatment were also classified as patients with inactive UC. Mucosa-associated microbiota was compared between non-IBD controls and UC patients using T-RFLP analysis. Microbiota in both the active and inactive phase was also analyzed in UC patients receiving antibiotic treatment. Results. T-RFLP patterns of mucosa-associated microbiota differed between active UC patients and non-IBD controls. Microbial compositions of active UC patients were significantly less diverse. The difference resulted from loss of commensals. From the viewpoint of disease activity before and after antibiotic combination treatment, T-RFLP patterns were also different between the active and inactive phases in the identical patients. Inactive UC patients possessed more diverse microbial compositions. No specific terminal restriction fragments were observed in UC patients. Conclusions. T-RFLP analysis showed that the mucosa-associated microbiota of patients with active UC differed from that of non-IBD controls. Active UC patients possessed significantly fewer diverse microbial compositions.

Comparison of Lafutidine and Rabeprazole in 7-day Second-line Amoxicillin- and Metronidazole-Containing Triple Therapy for Helicobacter pylori: A Pilot Study

Background:  Lafutidine is an H2‐receptor antagonist with gastroprotective action through capsaicin‐sensitive afferent neurons and relatively inexpensive compare to proton‐pump inhibitors (PPIs). A 7‐day course of PPIs–amoxicillin–metronidazole is recommended as standard second‐line Helicobacter pylori therapy and is covered by national health insurance in Japan. The aim of this study was to determine the efficacy and safety of second‐line eradication using the H2‐receptor antagonist lafutidine as a substitute for a PPI.

Fragmented CagA protein is highly immunoreactive in Japanese patients.

Background:  High‐molecular‐weight cell‐associated proteins (HM‐CAP) assay is the most popular serological immunoassay worldwide and has been developed from US isolates as the antigens. The accuracy is reduced when the sera are from adults and children in East Asia including Japan. To overcome the reduced accuracy, an enzyme immunoassay using Japanese strain–derived HM‐CAP (JHM‐CAP) was developed, in which the antigens were prepared by exactly the same procedure as HM‐CAP. The performance of JHM‐CAP was better than that of HM‐CAP in Japanese adults as well as in children. The higher sensitivity was because of the presence of 100‐kDa protein that was absent in the preparation of HM‐CAP antigen.

A study of the changes in the cause of peptic ulcer bleeding.

AIM To clarify the frequency of and changes in the cause of peptic ulcer bleeding. METHODS This study retrospectively evaluated the out- and inpatients who underwent endoscopy between 2002 to 2008. The subjects were patients presenting with peptic ulcer bleeding. The details of these patients were obtained from their endoscopic reports and medical records. RESULTS The rates of Helicobacter pylori (H. pylori) infection were significantly low (P = 0.039), while the proportion of nonsteroidal antiinflammatory drugs (NSAIDs) users and vascular disease significantly increased over the period studied (P = 0.034 and P = 0.04, respectively). However, there was no significant difference in the proportion of low-dose aspirin users (P = 0.832). CONCLUSION Its found that the primary cause of peptic ulcer bleeding changed from H. pylori infection to use of NSAIDs over the 7-year period of study. It seems that the number of low-dose aspirin users has increased with the increase in the proportion of vascular disease. It is necessary to take measures to prevent peptic ulcer bleeding among NSAIDs and low dose aspirin users.

The modified glucose clearance test: a novel non‐invasive method for differentiating non‐erosive reflux disease and erosive oesophagitis

Background  Impaired salivary secretion has been reported to cause abnormal acid clearance from the oesophagus in gastro‐oesophageal reflux disease (GERD). However, few studies have explained the differences between non‐erosive reflux disease (NERD) and erosive oesophagitis (EO) with respect to salivary secretion.

Infectious mononucleosis with atypical manifestations accompanied by transient IgM antibody response for cytomegalovirus

Infectious mononucleosis (IM) is a clinical syndrome caused by primary infection with Epstein–Barr virus (EBV) that is common in adolescents. In adults, particularly in elderly people, the clinical picture of IM tends to be atypical, often leading to a diagnostic challenge. Diagnosis is also complicated because infection with EBV can induce the synthesis of cross-reacting immunoglobulin M antibodies for other herpesviruses. We report an unusual case of infectious mononucleosis in a 34-year-old immunocompetent adult. Epidemiological studies indicate that the average age of primary EBV infection in developed countries is increasing. IM with atypical presentation will be a diagnostic challenge in the future as the number of EBV-naïve adults increases.

M1059 Impact of Efficacies of Triple Therapy Using Lafutidine Plus Amoxicillin-Metronidazole for Proton Pump Inhibitor-Amoxicillin-Clarithromycin Treatment Failures for Helicobacter pylori Infection

Background: The rate of gastric cancer in the Northwest Territories Aboriginal population is higher than the rest of the Canada. The aims of this study were to determine theHelicobacter pylori (Hp) prevalence and antibiotic resistance pattern in this community. Methods: As part of a community health project focused on Hp risks, including urea breath test (UBT) screening, residents (age ≥ 9 yrs) of Aklavik, a remote town of 620 inhabitants in the Northwest Territories of Canada, were invited to undergo endoscopy in February 2008. An on-site unit was assembled in the local health centre to perform upper gastrointestinal endoscopy with gastric biopsies for Hp culture and antibiotic susceptibility. Positive Hp cultures were tested using the E-test method for susceptibility to metronidazole, clarithromycin, amoxicillin, ciprofloxacin, tetracycline, nitrofurantoin, and rifampin. Results: Hp prevalence was 55% among the 240 residents who had a UBT. Of all eligible participants, 35% (n = 194) underwent endoscopy and biopsies for culture, with UBT-positive residents more likely to consent to endoscopy. The mean (±SD) age of the participants was 40 (±17) years and 59% were female. Hp culture results were available from 170; 117 (69%) were Hp positive. Antibiotic resistance was found in 33% (n = 33) of 99 Hp-positive cultures tested. Resistance to only metronidazole, clarithromycin, or amoxicillin was present in 23% (n = 23), 4% (n = 4), 0% (n = 0), respectively. There were no cases of resistance to rifampin and tetracycline. Multi-drug (≥ 2) resistance was present in 6 cases (6%). Conclusion: There is a high prevalence of Hp infection with relatively low levels of antibiotic resistance and occasional multi-drug resistance to antibiotics among residents in this Canadian arctic hamlet. A randomized control trial is being conducted to determine the optimal treatment to cure Hp infection in this community.

Update analysis: Thromboembolism in gastrointestinal tract cancer patients receiving chemotherapy.

e15156Background: We previously reported that TE incidence (TEi) was 14 % among Japanese gastrointestinal tract cancer (GTC) patients (pts) receiving chemotherapy (CTx), and it was significantly hi...

Thromboembolism incidence in patients with gastrointestinal tract cancer receiving chemotherapy: A single-institutional retrospective cohort analysis.

541 Background: Although cancer and its treatments are well-recognized risk factors for thromboembolism (TE), such as venous and pulmonary TE, there are very few data of the incidence of cancer associated TE in the Asian population. So we conducted a retrospective cohort study to investigate the TE incidence of gastrointestinal tract cancer (GTC) patients (pts) receiving chemotherapy in a Japanese community hospital’s daily practice setting. Methods: All the patients received chemotherapy for GTC in our hospital from January 2008 to May 2015 were identified through medical records review extracted by our hospital data warehouse. We analyzed the incidences of TE by reviewing all the reports of contrast-enhanced computed tomography performed on each patient during chemotherapy and identified the association between several clinicopathological factors and TE incidence using chi-square tests and logistic regression. Results: Five hundred fourteen Japanese GTC pts were analyzed on this study. Patient character...

Su1626 Diagnosis and Pathophysiological Evaluation of Functional Dyspepsia by a Novel Drinking-Ultrasonography Test

intragastric pressure was measured with a transducer until patients expressed gastric discomfort. Time to the threshold of gastric discomfort was measured and analyzed. After the first examination, rabeprazole (10 mg/day: for 4 NERD patients, 2 weeks), mosapride (15 mg/ day: for 5 FD patients (PDS 4, EPS 1), 2 weeks) or itopride (150 mg/day: for 3 FD patients (PDS 3), 2 weeks) were administered and additional insufflation tests were performed. Results: (1) Time to threshold of gastric discomfort: The time to reach threshold pressure was significantly shorter in the FD group and in the NERD group than in the healthy control group (P<0.05). Symptoms at the threshold were abdominal distention or stomachache. (2) The effect of medication on the time to threshold: The time to threshold with rabeprazole, mosapride or itopride was significantly longer than without medication. Conclusions: The results of this study suggest that the time to threshold of gastric discomfort may be useful for diagnosing FD. This method may also be useful for evaluating the efficacy of medication on the pathophysiology of FD.