Tatsuya Mikami

High Prevalence of the CagA-positive Helicobacter pylori Strains in Japanese Asymptomatic Patients and Gastric Cancer Patients

BACKGROUND Several studies have shown that infection of Helicobacter pylori strains possessing cagA is associated with atrophic gastritis and gastric cancers. METHOD In 58 pairs of early gastric cancer patients and sex- and age-matched controls, isolated H. pylori strains were tested for possession of cagA. The presence of atrophic gastritis was also examined. RESULTS Proportions of cagA-positive strains were 100% in cancer patients and 92.3% in controls. Atrophic gastritis was seen in 96.7% and 95.8% of cancer and control patients in whom cagA-positive strains (NS) were detected. However, it was seen in only 20% of H. pylori-negative control patients (P < 0.01). CONCLUSIONS The present results do not suggest any specific association between cagA-positive strains and gastric cancer. However, frequent prevalence of cagA-positive strains might be associated with the high incidence of atrophic gastritis in Japanese populations.

Effect of Helicobacter pylori eradication in the treatment of Japanese patients with chronic idiopathic urticaria

BackgroundInfection with Helicobacter pylori has been associated with chronic idiopathic urticaria (CIU). The aim of this study was to investigate the efficacy of H. pylori eradication in the treatment of patients with CIU.MethodsFifty patients with CIU (16 men and 34 women; age 25–75 years) and 100 sex- and age-matched control subjects were enrolled in the study. Presence of IgG antibody to H. pylori was examined by serology. H. pylori-seropositive patients with CIU received endoscopy to confirm H. pylori infection. Patients infected with H. pylori received eradication therapy comprising lansoprazole, amoxicillin, and either clarithromycin or metronidazole. At least 2 months after finishing the eradication therapy, a 13C-urea breath test was performed, and the effect of eradication therapy on the CIU was scored, using a three-point scale, as complete remission, partial remission, or no improvement.ResultsIn the 50 patients with CIU, 26 (52%) were H. pylori-seropositive, while 48% (48/100) of the control subjects were seropositive (statistically not significant). Nineteen out of the 26 patients with CIU infected with H. pylori received eradication therapy, and eradication was successful in 17 patients. In the 17 H. pylori-eradicated patients, 6 (35%) had complete remission and 11 (65%) had complete remission or partial remission. On the other hand, in the 9 patients without H. pylori eradication, only 2 (22%) showed partial remission and 7 (78%) had no improvement.ConclusionsEradication of H. pylori would be a valid choice for patients with CIU, although the prevalence of H. pylori infection is not higher in patients with CIU than it is in controls.

Efficacy of metronidazole for the treatment of clarithromycin-resistant Helicobacter pylori infection in a Japanese population

BackgroundEradication of Helicobacter pylori has become a common treatment for several diseases. There is an increase in antibiotic-resistant strains, which causes the failure of eradication. The aim of this study was to investigate the usefulness of metronidazole for the treatment of H. pylori infection in patients who failed eradication therapy.MethodsSeventy H. pylori-positive patients who had failed eradication treatment with first-line triple therapy, which consisted of a proton pump inhibitor, amoxicillin, and clarithromycin, were enrolled into the study. Before the second-line therapy, patients underwent endoscopy to obtain H. pylori strains to test susceptibility to antibiotics. Lansoprazole (30 mg b.d.), amoxicillin (750 mg b.d.), and metronidazole (250 mg b.d.) were administered for 1 week, and the result was tested by 13C-UBT.ResultsH. pylori was isolated from 62 patients, and 52 of them (83.9%) were clarithromycin resistant. There was no amoxicillin- or metronidazole-resistant strain. No major adverse effects were seen, and all the patients completed the 1-week regimen. The eradication rates of lansoprazole-amoxicillin-metronidazole were 96.2% (51/53; 95% CI, 87.0%–99.5%) using both intention-to-treat analysis and per protocol analysis.ConclusionsLansoprazole-amoxicillin-metronidazole triple therapy is an effective and promising second-line H. pylori eradication therapy in a north Japanese population, which has a low frequency of metronidazole resistance.

A case of early-stage primary malignant melanoma of the esophagus

From the First Department of Internal Medicine, the First Department of Surgery, and Central Pathology, Hirosaki University School of Medicine, Hirosaki, Japan. Reprint requests: Shinsaku Fukuda, MD, First Department of Internal Medicine, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, 0368562 Aomori, Japan. Copyright

Histological analysis of gastritis and Helicobacter pylori infection in patients with early gastric cancer: a case-control study.

Infection with Helicobacter pylori is associated with an increased risk of gastric adenocarcinoma. However, most patients with H. pylori infection will not develop gastric cancer. The aims of the present study were to examine which histological features, including H. pylori infection, would increase the risk of gastric cancer using a case‐control study.

Healing of cimetidine-resistant Ménétrier's disease by eradication of Helicobacter pylori infection.

We report a case of Ménétriers disease associated with hypoproteinemia who was successfully treated by eradication of Helicobacter pylori infection. A 26-year-old woman had diffuse giant gastric folds with proven protein leakage from the stomach. She received cimetidine, famotidine, and omeprazole for more than 3 months with little benefit. H. pylori infection was detected, and she was treated with clarithromycin (200 mg three times a day), lansoprazole (30 mg/day), and ecabet sodium (1.5 g twice a day) for 2 weeks. After starting the treatment, rapid increase of serum albumin and IgG levels were observed. The treatment resulted in eradication of H. pylori infection, and serum albumin and IgG levels returned to normal. Histologic specimens also showed the improvement of the irregularly elongated gastric pits with inflammatory infiltrates after the treatment. This case report suggests that eradication of H. pylori is recommended therapy for the immediate improvement of Ménétriers disease associated with hypoproteinemia.

A Case of Giant Gastric Folds with Hypoalbuminemia Healed by Helicobacter pylori Eradication

A 66‐year‐old man with hypoalbuminemia was found to have diffuse giant mucosal folds in the body of the stomach. Helicobacter pylori (H pylori) status was evaluated by several examinations, all of which showed positive results. To eradicate H pylori, he was treated with clarithromycin (200mg b. i. d.), lansoprazole (30mg q. d.) and plaunotol (80mg t. i. d.). By two weeks, the serum albumin concentration had risen to 3.4g per dl. Four weeks after finishing clarithromycin therapy, endoscopy was repeated and H pylori status was evaluated as before. All examinations showed negative results and the giant mucosal folds had improved markedly. Before treatment, histological specimens showed irregular elongation of pits with inflammatory infiltrates. After treatment, the architecture of pits returned to its normal form with decreased inflammatory infiltrates. In this case, giant gastric folds and hypoalbuminemia were improved by H pylori eradication, suggesting that H pylori infection may play a role in the giant gastric folds associated with hypoalbuminemia.

Gastric lipoma successfully treated by endoscopic unroofing

A 64‐year‐old Japanese man was diagnosed with a tumor of the stomach. From the findings of an upper gastrointestinal endoscopy, computed tomography scan and endoscopic ultrasonography, the tumor was suggestive of a gastric lipoma. He was successfully treated by an endoscopic unroofing technique. There remained residual tumor just after unroofing, but it disappeared a month later. There remained only a scar and there has been no recurrence.

Evaluation of scoring models for identifying the need for therapeutic intervention for upper gastrointestinal bleeding: a new prediction score model for Japanese patients

Multiple scoring systems have been developed to predict outcomes in patients with upper gastrointestinal bleeding. We determined how well these and a newly established scoring model predict the need for therapeutic intervention, excluding transfusion, in Japanese patients with upper gastrointestinal bleeding.

ENDOSCOPIC QUANTIFICATION OF MUCOSAL SURFACE ROUGHNESS FOR GRADING SEVERITY OF ULCERATIVE COLITIS

Background:  Mucosal surface roughness is the element of Matts grading system for endoscopic severity of ulcerative colitis. The aims of the present study were to develop an image‐processing method for quantifying mucosal surface roughness and to evaluate performance of this method by comparison with visually assessed surface roughness.