Yuji Maehata

Long-term effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cancer.

BACKGROUND A prospective, randomized trial proved that Helicobacter pylori eradication significantly reduces the incidence of metachronous gastric cancer during a 3-year follow-up. OBJECTIVE To investigate the long-term effect of H pylori eradication on the incidence of metachronous gastric cancer after endoscopic resection of early gastric cancer. DESIGN Retrospective, multicenter study. SETTING Kyushu University Hospital and 6 other hospitals in Fukuoka Prefecture, Japan. PATIENTS AND INTERVENTIONS Follow-up data for 268 H pylori-positive patients who had undergone endoscopic resection of early gastric cancer were retrospectively investigated. A total of 177 patients underwent successful H pylori eradication (eradicated group), whereas 91 had persistent H pylori infection (persistent group). MAIN OUTCOME MEASUREMENTS The incidence of metachronous gastric cancer was compared in these 2 groups. RESULTS When the follow-up period was censored at 5 years, the incidence rate in the eradicated group was lower than that observed in the persistent group (P = .007). During the overall follow-up period ranging from 1.1 to 11.1 years (median 3.0 years), metachronous gastric cancer developed in 13 patients (14.3%) in the persistent group and in 15 patients (8.5%) in the eradicated group (P = .262, log-rank test). Based on a multivariate logistic regression analysis, baseline severe mucosal atrophy and a follow-up of more than 5 years were found to be independent risk factors for the development of metachronous gastric cancer. LIMITATIONS Retrospective study. CONCLUSIONS H pylori eradication does not reduce the incidence of metachronous gastric cancer. H pylori eradication should be performed before the progression of gastric mucosal atrophy.

Endoscopic diagnosis of superficial non‐ampullary duodenal epithelial tumors in Japan: Multicenter case series

To verify the current status in Japan on endoscopic diagnosis of superficial non‐ampullary duodenal epithelial tumors (SNADET) by a multicenter case series through a questionnaire survey.

Comparison of the therapeutic efficacy and safety between tacrolimus and infliximab for moderate-to-severe ulcerative colitis: a single center experience

Abstract Objective Both tacrolimus (Tac) and infliximab (IFX) are effective for moderate-to-severe ulcerative colitis (UC). The aim of this study was to compare the therapeutic efficacy and safety of both drugs. Materials and methods We performed a retrospective analysis of 46 patients with moderate-to-severe UC who were treated either by Tac (n = 21) or IFX (n = 25). We compared the remission and response rates for 10 weeks between the two groups. In patients who achieved a clinical response, the subsequent relapse rate was compared. The overall adverse events were also compared between the two groups. Results The remission and response rates at week 10 did not differ between patients treated with Tac (67% and 86%, respectively) and patients treated with IFX (76% and 92%, respectively). Among 41 patients showing a clinical response, eight of 23 patients treated with IFX and eight of 18 patients treated with Tac showed a subsequent relapse. The risk of relapse was not different between the two groups. While no serious adverse events were observed, the incidence of adverse events was higher in patients treated with Tac than in those treated with IFX. Conclusion Tac and IFX may be equally efficacious for the induction and maintenance of remission in patients with UC while minor adverse events are more frequent with the former treatment.

Duodenal adenomatosis in Japanese patients with familial adenomatous polyposis

Duodenal adenomatosis is the most frequent extracolonic manifestation of familial adenomatous polyposis (FAP), and duodenal cancer has been assumed to be the second most significant cause of death in patients with the disease. To stratify the risk of duodenal cancer, Spigelmans classification was proposed for the staging of duodenal adenomatosis. According to Western guidelines, patients with stage IV of the classification are candidates for prophylactic duodenectomy. Since our institutional experience disclosed only 2% of duodenal or ampullary cancers among 130 patients with FAP, and because most duodenal adenomatosis remains unchanged under endoscopic surveillance, it seems likely that aggressive endoscopic or surgical removal is unnecessary for most FAP patients with duodenal adenomatosis. In the present article, we demonstrate our data and present our strategy for duodenal adenomatosis of FAP.

Giant Inflammatory Polyposis of the Cecum With Repeated Intussusception in Ulcerative Colitis: Report of a Case

Giant Inflammatory Polyposis of the Cecum With Repeated Intussusception in Ulcerative Colitis: Report of a Case

The influence of CYP2C19 polymorphisms on exacerbating effect of rabeprazole in celecoxib‐induced small bowel injury

Simultaneous use of proton pump inhibitors (PPIs) has been shown to increase the risk of nonsteroidal anti‐inflammatory drug (NSAID)‐induced small bowel injury.

Therapeutic Strategy for Crohn's Disease with a Loss of Response to Infliximab: A Single-Center Retrospective Study

Background/Aims: Infliximab (IFX) is an effective treatment for maintaining clinical remission in patients with initially moderate-to-severe Crohns disease (CD). However, a certain number of patients become unresponsive to IFX, subsequently requiring intensified therapy. The aim of this study was to compare the short- and long-term therapeutic efficacy of intensified regimens in CD patients who fail to respond to IFX. Methods: The clinical courses of 33 CD patients who failed to respond to treatment with IFX were investigated retrospectively. An intensified regimen involving doubling the dose of IFX was chosen in 13 patients (DD group) versus shortening the IFX interval in 13 patients (SI group) and switching to adalimumab (ADA) in 7 patients (SA group). Results: The clinical response and rate of clinical remission at 4 weeks were 62 and 54% in the DD group, 77 and 62% in the SI group and 57 and 43% in the SA group, respectively (p = 0.59 for clinical response, p = 0.90 for clinical remission). The rate of sustained remission at 48 weeks was 44% in the DD group, 54% in the SI group and 33% in the SA group (p = 0.88). Conclusion: The short- and long-term efficacy of doubling the dose of IFX, shortening the interval of IFX or switching to ADA is similar for CD patients who no longer respond to IFX.

Characteristics of primary and metachronous gastric cancers discovered after helicobacter pylori eradication: A multicenter propensity score-matched study

Background/Aims Gastric cancers develop even after successful Helicobacter pylori eradication. We aimed to clarify the characteristics of early gastric cancers discovered after H. pylori eradication. Methods A total of 1,053 patients with early gastric cancer treated by endoscopic submucosal dissection were included. After matching the propensity score, we retrospectively investigated the clinicopathological features of 192 patients, including 96 patients who had undergone successful H. pylori eradication (Hp-eradicated group) and 96 patients who had active H. pylori infection (Hp-positive group). Results In the Hp-eradicated group, early gastric cancers were discovered 1 to 15 years (median, 4.1 years) after H. pylori eradication. Compared with Hp-positive patients, Hp-eradicated patients showed a more frequently depressed configuration (81% vs 53%, respectively, p<0.0001) and a higher trend toward submucosal invasion (18% vs 8%, respectively, p=0.051). A multivariable analysis revealed the macroscopic depressed type to be characteristics of early gastric cancers after H. pylori eradication. Among patients in the Hp-eradicated group, metachronous cancers showed less frequent depressed lesions (68% vs 84%, respectively, p=0.049) and smaller tumor sizes (median, 11 mm vs 14 mm, respectively, p=0.014) than primary cancers. Conclusions Early gastric cancers after H. pylori eradication are characterized by a depressed configuration. Careful follow-up endoscopies are necessary after H. pylori eradication.

Rectal neuroendocrine carcinoma associated with long‐standing ulcerative colitis: Report of a case

A 45-year-old woman with 20 years duration of ulcerative colitis (UC) was referred to our hospital for scrutiny of rectal high-grade dysplasia (HGD). Under colonoscopy, a nodular protrusion covered by normalappearing mucosa with irregular depression on top was found in the lower rectum (Fig. 1a). Magnifying endoscopy demonstrated increased vascular intensity with irregularly dilated vessels under narrow-band imaging (NBI) and indistinct pit pattern under crystal violet staining in the depressed area (Fig. 1b,c). Endosonographically, the lesion was depicted as a hypoechoic lesion with a small hyperechoic area in the submucosa (Fig. 1d). As distant metastasis was not evident, she underwent total proctocolectomy. Histological examination revealed that the tumor was the composition of submucosal proliferation of uniform cells with mediumto large-sized round atypical nuclei and intraepithelial HGD (Fig. 2a–d). Immunohistochemically, submucosal tumor cells were positive for chromogranin A, synaptophysin and CD56, and the Ki-67 index was >80% (Fig. 2e). We thus diagnosed the lesion to be the composite tumor of neuroendocrine carcinoma (NEC) and HGD associated with UC. Low-grade dysplasia was also determined in the descending colon. Because NEC massively invaded into the submucosa accompanying vessel permeation and lymph node metastases, adjuvant chemotherapy was applied. However, liver and lung metastases appeared 11 months after surgery. Although approximately half of UC-associated neoplasia has been reported to possess a feature of neuroendocrine differentiation, colorectal neuroendocrine tumors (NET) are rarely seen in patients with UC. However, considering that HGDwas commonly found in the adjacent mucosa of NET, possible contribution of UC to the development of NET also seems plausible. Our case manifested submucosal tumor-like protrusion with irregular depression, where NEC was histologically exposed on the surface. Magnifying observation with NBI found in the depressed area of such protrusion may help surmise the composition of NEC in long-standing UC. Authors declare no conflicts of interest for this article.

Rectal neuroendocrine carcinoma associated with long-standing ulcerative colitis.

A 45-year-old woman with 20 years duration of ulcerative colitis (UC) was referred to our hospital for scrutiny of rectal high-grade dysplasia (HGD). Under colonoscopy, a nodular protrusion covered by normalappearing mucosa with irregular depression on top was found in the lower rectum (Fig. 1a). Magnifying endoscopy demonstrated increased vascular intensity with irregularly dilated vessels under narrow-band imaging (NBI) and indistinct pit pattern under crystal violet staining in the depressed area (Fig. 1b,c). Endosonographically, the lesion was depicted as a hypoechoic lesion with a small hyperechoic area in the submucosa (Fig. 1d). As distant metastasis was not evident, she underwent total proctocolectomy. Histological examination revealed that the tumor was the composition of submucosal proliferation of uniform cells with mediumto large-sized round atypical nuclei and intraepithelial HGD (Fig. 2a–d). Immunohistochemically, submucosal tumor cells were positive for chromogranin A, synaptophysin and CD56, and the Ki-67 index was >80% (Fig. 2e). We thus diagnosed the lesion to be the composite tumor of neuroendocrine carcinoma (NEC) and HGD associated with UC. Low-grade dysplasia was also determined in the descending colon. Because NEC massively invaded into the submucosa accompanying vessel permeation and lymph node metastases, adjuvant chemotherapy was applied. However, liver and lung metastases appeared 11 months after surgery. Although approximately half of UC-associated neoplasia has been reported to possess a feature of neuroendocrine differentiation, colorectal neuroendocrine tumors (NET) are rarely seen in patients with UC. However, considering that HGDwas commonly found in the adjacent mucosa of NET, possible contribution of UC to the development of NET also seems plausible. Our case manifested submucosal tumor-like protrusion with irregular depression, where NEC was histologically exposed on the surface. Magnifying observation with NBI found in the depressed area of such protrusion may help surmise the composition of NEC in long-standing UC. Authors declare no conflicts of interest for this article.