Dabigatran-induced esophagitis: The prevalence and endoscopic characteristics.

BACKGROUND AND AIM: There have been some descriptions of dabigatran-induced esophagitis in the literature. The aim of this study was to examine the prevalence and endoscopic characteristics of the disease. METHODS: We reviewed the endoscopic database and medical records of 91 patients with dabigatran internal use who underwent upper gastrointestinal endoscopy. The frequency of dabigatran-induced esophagitis and its endoscopic findings were retrospectively analyzed. In addition, the clinical characteristics were compared between patients with dabigatran-induced esophagitis and those without the disease. RESULTS: Dabigatran-induced esophagitis was found in 19 of 91 (20.9%) patients. Of the 19 patients with the esophagitis, 18 (94.7%) showed longitudinally sloughing epithelial casts in the mid and/or lower esophagus, which may be characteristic endoscopic findings of this disease. Symptomatic patients were more frequent in patients with dabigatran-induced esophagitis (68.4%) than those without (37.5%, P = 0.02). Other factors including age, gender, coexistence of hiatal hernia, gastroesophageal reflux disease, or concomitant other medications did not differ between the two groups. CONCLUSIONS: Dabigatran causes the esophageal mucosal injury in approximately 20% of patients. Longitudinally sloughing casts in the distal esophagus are characteristic of dabigatran-induced esophagitis.

Serial changes of cytokines in Crohn's disease treated with infliximab.

BACKGROUND/AIMS: Infliximab (IFX) has been reported to be useful as induction therapy and/or maintenance therapy for Crohn's disease (CD). However, the effects of IFX on serial changes in cytokine levels have not been well characterized. We examined cytokine levels in CD patients before and after administration of IFX. METHODOLOGY: A total of 37 patients with active CD were enrolled (24 men, 13 women; mean age, 31.9 years). Patients were given IFX 5mg/kg intravenously. Serum levels of 17 cytokines were simultaneously determined using a Bio-Plex suspension array system before treatment and, 4 and 8 weeks after IFX treatment. Patients were divided into two groups according to the disease duration: the 'early treatment' group and the 'in progress' treatment group. RESULTS: Serum IL-6, IL-7, IL-8 and MIP-1ß levels were significantly decreased in CD patients after IFX treatment compared to before treatment (p<0.05). In particular, serum levels of IL-8, IL-12 and MIP-1ß decreased significantly after IFX treatment in the 'in progress' treatment group. The changes in CD activity score (CDAI) after treatment were positively correlated with the changes of serum MIP-1ß. CONCLUSIONS: IFX treatment reduces serum levels of IL-6, IL-7, IL-8, IL-12 and MIP-1ß, which appears to be mediated by the inhibition of inflammation in CD.

Association between tumor necrosis factor-alpha and Fc-gamma receptor polymorphisms with infliximab in Crohn's disease.

BACKGROUND/AIMS: The associations between tumor necrosis factor-alpha (TNF-alpha) and Fcgamma receptor (FcgammaR) polymorphisms with infliximab (IFX) treatment of Crohn's disease (CD) are not well known. The aim of this study was to evaluate the association between these polymorphisms and IFX treatment of CD. METHODOLOGY: DNA was obtained from 41 CD patients (13 females, 28 males). TNF-alpha and FcgammaR polymorphisms were determined by the polymerase chain reaction-based restriction fragment length polymorphism method. Patients were given IFX 5 mg/kg intravenously and were followed prospectively for 8 weeks. The CD activity index (CDAI) was measured before and 8 weeks after treatment. Patients were classified as responders or non-responders according to the CDAI. RESULTS: The distribution of TNF-alpha, FcgammaRIIA, and FcgammaRIIIA genotypes was not significantly different between responders and non-responders 8 weeks after treatment. The distribution of FcgammaRIIIB genotypes significantly differed between responders and non-responders after 8 weeks (P < 0.05). CONCLUSIONS: FcgammaRIIIB polymorphisms may be an important factor for clinical response to IFX treatment in CD.

Evaluation of Infliximab Effects on Gastrointestinal Bleeding in Crohn's Disease Using Double-Balloon Endoscopy.

Tumor necrosis factor α plays an important role in the pathogenesis of Crohn's disease (CD). The effects of infliximab on gastrointestinal bleeding in CD have not yet been fully evaluated. Herein we describe three CD cases who presented with gastrointestinal bleeding and received infliximab treatment. In case 1, double-balloon endoscopy showed a large ulcer with several irregularly shaped ulcers in the terminal ileum; 8 weeks after infliximab administration, complete healing of all lesions was observed. In case 2, double-balloon endoscopy showed linear ulcers and mucosal edema in the jejunum and ileum; 5 weeks after infliximab administration, all lesions were decreased in size and were healed. In case 3, double-balloon endoscopy revealed ulcerations and stenosis in the terminal ileum; 12 weeks after infliximab administration, ulcer healing and an increased diameter of the ileal stenosis were observed. These three cases have been receiving ongoing infliximab maintenance therapy and are currently symptom-free. Infliximab thus appears to be useful for treatment of gastrointestinal bleeding in CD patients.

Characterization of follicular lymphoma in the small intestine using double-balloon endoscopy.

Follicular lymphomas occur rarely in the gastrointestinal tract, representing only 1-3% of all gastrointestinal tract B-cell non-Hodgkin lymphomas. We describe endoscopic analysis of 3 cases of follicular lymphoma in the small intestine using double-balloon endoscopy. Double-balloon endoscopy revealed multiple nodular lesions and elevated white patches, multiple polypoid lesions, and scattered white polypoid and nodular lesions in the duodenum and small intestine. Fuji Intelligent Chromo Endoscopy demonstrated small, whitish nodules, and narrow-band imaging showed a coiled, elongated vascular pattern within the elevated lesions. These cases are the first follicular lymphomas in the small intestine evaluated using narrow-band imaging or Fuji Intelligent Chromo Endoscopy to be reported.