Tetsu Endo

Serological analysis of Helicobacter hepaticus infection in patients with biliary and pancreatic diseases

Background and Aims:  Infection with Helicobacter hepaticus has been associated with development of hepatocellular carcinoma and gallstones in animal models. In humans, however, the association of H. hepaticus infection with biliary and pancreatic diseases has not been elucidated. The aim of this study was to serologically examine the prevalence of H. hepaticus infection in patients with biliary and pancreatic diseases.

Two Cases of Primary Sclerosing Cholangitis Overlapping with Autoimmune Hepatitis in Adults

Overlap syndrome between primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) is extremely rare in Japan. We herein report two adult patients with PSC-AIH overlap syndrome. They were diagnosed with PSC-AIH overlap syndrome based on the findings of endoscopic retrograde cholangiography and liver biopsy, and using the International Autoimmune Hepatitis Group scoring system. In both cases, PSC preceded AIH, and combination therapy with steroid and ursodeoxycholic acid was effective. Because there are few reported cases in Japan, it is important to study more cases to shed light on the clinical and pathological features of PSC-AIH overlap syndrome.

Development of Hepatocellular Carcinoma in Chronic Hepatitis C Patients 20 Years after Achieving a Sustained Virological Response with Interferon Therapy: A Report of Two Cases

Advances in interferon (IFN)‐based therapy for chronic hepatitis C have led to a high rate of sustained virological response (SVR), which means viral clearance. However, some cases have been reported to develop hepatocellular carcinoma (HCC) over 10 years after achieving the SVR. Here, we report two patients who developed HCC 20 years after SVR with IFN therapy. Both of the patients were male and achieved SVR at the age of 46 years and 61 years, respectively. These cases suggest the need for long‐term follow‐up in patients with chronic hepatitis C even if SVR is achieved.

Interventional Treatment for Giant Hepatic Hemangioma Accompanied by Arterio-portal Shunt with Ascites

A 73-year-old woman with massive ascites associated with a giant hepatic mass accompanied by arterio-portal (AP) shunt was admitted to our hospital. Based on contrast-enhanced computed tomography (CT) and angiography findings, hepatic hemangioma with AP shunt and ascites due to portal hypertension was diagnosed. Transcatheter arterial embolization (TAE) by N-butyl-2-cyanoacrylate (NBCA) was performed without complications. The patients ascites disappeared, and her liver function test results improved after the treatment. The patient has maintained a steady state for two years. This case indicates that TAE with NBCA is a safe and effective treatment for hepatic hemangioma accompanied by AP shunt.

Kidney Injury due to Ureteral Obstruction Caused by Compression from Infected Simple Hepatic Cyst

Simple hepatic cysts are common and most often asymptomatic. In symptomatic cases, hemorrhage, rupture, and infection are major complications. However, urinary tract obstruction caused by a simple hepatic cyst is rare. We treated an 82-year-old Japanese man with an infected giant hepatic cyst causing right hydronephrosis who had a past history of left nephrectomy for renal cell carcinoma. The patient underwent ultrasound-guided percutaneous drainage and sclerotherapy with minocycline hydrochloride for the infected hepatic cyst. Right hydronephrosis was relieved, and renal dysfunction improved with regression of the hepatic cyst after treatment. This is the first report of hydronephrosis due to ureteral obstruction caused by compression from a hepatic cyst.

Crohn's Disease Initially Suggested by Minute Esophageal Erosions-Report of a Case

A 19–year‐old woman visited our hospital complaining of fever and epigastral‐gia. Upper gastrointestinal endoscopy showed minute discrete erosions surrounded by elevated mucosa about one millimeter in diameter in the esophagus and aphthoid erosions in the stomach. Biopsy samples obtained from the esophagus showed non‐caseating epitheloid granulomas, suggesting Crohns disease. Colonoscopy showed a small erosion in the cecum adjacent to the vermiform appendix and biopsy showed non‐caseating epitheloid granulomas and Crohns disease was diagnosed. In hospital, she was treated with elemental diet and 5–aminosalicyclic acid. Clinical symptoms disappeared rapidly and laboratory data became normal. We thus report a rare case of early‐stage Crohns disease initially indicated by biopsy of minute esophageal erosions. (Dig Endosc 1999; 11: 255–258)

Applicability of Polymerase Chain Reaction Assay for Detecting Helicobacter pylori in Gastric Juice Aspirates

Abstract: Polymerase chain reaction (PCR) is a useful method of detecting H. pylori from gastric juice, which can be obtained more safely and easily than gastric biopsies. We investigated the applicability of PCR assays of gastric juice aspirates to evaluate cure of H. pylori infection. Fifteen H. pylori positive patients with gastric ulcer or gastritis received anti H. pylori therapy. Four weeks after the cessation of treatment, endoscopy and the 13C‐urea breath test (13C‐UBT) were performed to evaluate the status of H. pylori infection. Gastric juice samples were collected and one biopsy specimen each was taken from the antrum and the body of the stomach. Results obtained from PCR of gastric juice aspirates were compared with those from PCR of gastric mucosae and 13C‐UBT. Fourteen of the 15 showed identical results. However, PCR assays of gastric juice aspirates were positive in one patient with negative results on the other two examinations. Restriction fragment length polymorphism of PCR products suggested that this discrepancy was due to detection of another strain passing through the stomach into the duodenum. Despite the detection of transient strains in gastric juice aspirates being infrequent, the results suggest the possibility of oral transmission of this organism.