Taro Ishii

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.

Modified 13C-octanoate breath test and impact of sampling points.

In recent years, the 13C-octanoate breath test has attracted attention as a simple and noninvasive method of assessing gastric emptying of solids. However, practical procedures for test meals, parameters used, and sampling points have not yet been established. Moving toward a more convenient method, here we examined the influences of sampling interval and duration on the 13C-octanoate breath test performed on 15 healthy subjects using a commercially-available instant cupcake. Breath samples were obtained every 15 minutes within 4 hours, and every 30 minutes in the subsequent 2 hours. Using computer simulation, the time it took for the fitting curve to peak (Tpeak) was calculated in each setting with each interval (15, 30, 60, and 120 minutes) and test duration (3, 4, 5, and 6 hours). When the sampling interval widened over 30 minutes, the difference from the original 6-hour data became larger than 20% of the coefficient of variance. When the sampling duration was shortened to 3 hours, no appropriate fitting curve could be achieved. These results suggest that a sampling duration of 4 hours at 30-minute intervals seems to be suitable for practical use of the test.

Urinary Antibody Titers to Helicobacter pylori and an Impact of Clinical Characteristics

This study evaluates the clinical usefulness of titers of antibody to Helicobacter pylori (Hp) in a urine-based enzyme-linked immunosorbent assay (URINELISA; Otsuka Pharmaceutical, Tokushima, Japan) by comparing values of serum antibody to Hp in an already commercialized kit in a population of 250 asymptomatic individuals. Influences of physical and laboratory characteristics on the relationship between serum and urinary titers of antibody to Hp were also estimated using simple and multiple regression analyses. Specific urine gravity, urine pH, proteinuria, and age of the subjects were regarded as significant factors relating to urinary titers of the anti-Hp antibody on simple regression analyses. Both the urinary and serum titers strongly correlated on simple regression analysis (r = 0.782, P < 0.0001). On multiple regression analysis, an additional two factors, specific urine gravity and urine pH, were picked up, and the correlation coefficient was improved (r = 0.795, P < 0.0001). The present results indicate that URINELISA had not only qualitative but quantitative accuracy. However, careful attention should be paid to cases with abnormalities in urinalysis when used quantitatively.

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.

High prevalence of gastroduodenal mucosal injury in patients taking selective serotonin reuptake inhibitors.

Dear Editor, Selective serotonin reuptake inhibitors (SSRI), an antidepressant medicine, are widely used in current clinical settings because of less-frequent adverse effects compared with classical antidepressants. Recent studies have indicated that patients taking SSRI are predisposed to gastrointestinal hemorrhage, probably due to the inhibitory effect of antiplatelet aggregation. However, there is no endoscopic evidence regarding patients taking SSRI, so we conducted the present study based on endoscopic records, to examine whether or not the prevalence of gastroduodenal mucosal injury is higher. From January 2006 to December 2007, 5555 patients underwent upper gastrointestinal endoscopy at Teikyo University Hospital (Tokyo, Japan). The medications of all patients were examined from medical charts, and 68 patients who had taken SSRI (fluvoxamine maleate or paxetine hydrochloride) for at least 2 weeks were enrolled at first. Patients who had a past history of upper gastrointestinal operation, a severe systemic condition, or those with co-administration of proton pump inhibitors, histamine 2 receptor antagonists or non-steroidal anti-inflammatory drugs were excluded, and 52 patients were finally selected as the study subjects. As control subjects, age( 2 years) and sex-matched asymptomatic patients who underwent endoscopy for cancer screening were randomly chosen from the patients list.Two well-trained experts in endoscopy evaluated the endoscopic record retrospectively with a blind fashion to patient information, to determine the presence or absence of erosive esophagitis and gastroduodenal mucosal injury (obvious mucosal defect including ulcer and erosion). Table 1 shows the result of endoscopic findings. The prevalence of gastroduodenal injury in patients taking SSRI was significantly higher than that in the control, whereas erosive esophagitis was not found in SSRI users as frequently. The present data suggest that patients taking SSRI are more likely to have gastroduodenal mucosal injury than those not taking SSRI. The high prevalence of gastrointestinal bleeding in SSRI users, as previously reported, may be partially attributed to the high presence of mucosal injury. Because of several limitations of the present study, such as an uncontrolled retrospective design and a small sample number, further research is necessary to confirm the safety of SSRI.

Synovial sarcoma metastatic to stomach and duodenum

A 49-year-old Japanese man presented witha painful mass on his right calf that was foundby histopathologic and immunohistochemical anal-yses of an open biopsy specimen to be a synovialsarcoma of the monophasic fibrous type. An SYT-SSX1 fusion gene, resulting from the chromosomaltranslocation of t(x;18)(p11.2;q11.2) was detected byreverse transcription polymerase chain reaction.After amputation of his right leg, the patientunderwent chemotherapy and radiotherapy to treatlung metastases. Subsequently, he developed me-lena and was found to be anemic. Upper endoscopydemonstrated multiple protruding lesions with acentral depression in the stomach and duodenum(A,B,C).Freshclotwasattachedtooneofthelesions.Biopsy specimens from one of the gastric lesionsrevealed spindle cell proliferation in the mucosa(D, H&E, orig. mag. 333) that was similar to thesynovial sarcoma from the right calf.

Metronidazole-Induced Neurotoxicity Developed in Liver Cirrhosis

A 68 year-old-male with hepatitis C-positive liver cirrhosis was admitted because of liver abscess. After metronidazole was initiated against the infection, mental disturbance appeared. Hepatic encephalopathy was suspected at first, however, the brain MRI showed hyperintense lesion of the bilateral basal dendric nuclei which indicated metronidazole-associated encephalopathy. The symptoms became well after cessation of the drug. Metronidazole is a widely used medicine against various infections. Recent case reports describe that this medicine can induce reversible encephalopathy. However, there have been few reports regarding metronidazole-induced encephalopathy occurred in patients with cirrhosis. Here we report on a case of hepatic cirrhosis and abscess in which reversible metronidazole-induced encephalopathy developed.

Endoscopic hemostasis techniques for upper gastrointestinal hemorrhage: A review.

Upper gastrointestinal hemorrhage (UGIH) is an urgent disease that is often encountered in daily medical practice. Endoscopic hemostasis is currently indispensable for the treatment of UGIH. Initially, when UGIH is suspected, a cause of UGIH is presumed from the medical interview and physical findings. After ample primary treatment, urgent endoscopy is performed. Many methods of endoscopic hemostasis are in wide use, including hemoclip, injection and thermo-coagulation methods. Although UGIH develops from a wide variety of diseases, such as esophageal varices and gastric and duodenal ulcer, hemostasis is almost always possible. Identification of the causative diseases, primary treatment and characteristic features of endoscopic hemostasis are needed to allow appropriate treatment.

Diagnosis of Helicobacter pylori infection using RAPIRUN®H. pylori antibody detection kit

Accurate diagnosis of Helicobacter pylori infection is essential in today’s clinical settings. Additionally, because of the widespread prevalence of this infection, noninvasive and convenient techniques are required for screening purposes. RAPIRUN®H. pylori antibody detection kit (Otsuka Pharmaceutical Co., Ltd, Tokyo, Japan) enables a diagnosis within 20 min using a random, single-voided urine specimen. Thus it is especially suited for use in point-of-care settings. The sensitivity and specificity are acceptable and comparable with other available methods. Here we provide an overview of the RAPIRUN kit.

No Relationship between Plasma Desacyl-Ghrelin Levels and Rabeprazole-Related Delay in Gastric Emptying

AbstractBackground and objective: Recent studies have indicated that rabeprazole, a proton pump inhibitor, delays gastric emptying. However, the mechanism of action remains unclear. We conducted this study to clarify whether desacylghrelin (the inactive form of the endogenous growth hormone secretagogue receptor ghrelin) is involved in rabeprazole-induced changes in gastric motor function. Methods: Twelve healthy males underwent 13C-acetate breath tests to evaluate gastric emptying of a liquid meal twice after administration of rabeprazole 20 mg/day for 3 days or no medication (control). Gastric emptying was evaluated by two parameters: half-emptying time and time to peak 13CO2 excretion. Plasma desacyl-ghrelin levels were measured in blood samples collected at three time points: immediately pre-test and 1 and 2 hours after ingestion of the test meal. Results: Rabeprazole significantly delayed gastric emptying of the liquid meal. However, plasma desacyl-ghrelin levels after ingestion of the liquid meal showed little difference before or after rabeprazole administration. Conclusion: The results indicate that desacyl-ghrelin was not associated with changes in gastric emptying caused by rabeprazole.