Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 70
Filtrar
Más filtros

Bases de datos
País/Región como asunto
Tipo del documento
País de afiliación
Intervalo de año de publicación
1.
Digestion ; 93(2): 111-20, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26637113

RESUMEN

BACKGROUND: Esomeprazole has been reported to show a strong acid suppression following preprandial as compared to postprandial administration, though no known study has compared the acid suppressing effects of other proton pump inhibitors between those administrations. The aim of this study was to compare intragastric pH levels following pre- and postprandial administrations of rabeprazole and esomeprazole. METHODS: In 15 Helicobacter pylori-negative healthy volunteers, we measured intragastric pH after 7 days of pre- and postprandial administrations of rabeprazole (10 mg) or esomeprazole (20 mg) using a 5-way crossover design. RESULTS: Preprandial administration of esomeprazole showed stronger acid suppression than postprandial administration. The values for percent time at pH >4.0 over a 24-hour period increased from 45.3% with postprandial administration of esomeprazole to 54.4% with preprandial administration, while the percent time at pH >4.0 during daytime was increased to a greater extent from 51.4 to 66.5% with preprandial administration (p = 0.05). On the other hand, the acid suppressing effect of rabeprazole was not influenced by the timing of administration. CONCLUSIONS: The acid suppressing effect of esomeprazole is influenced by administration timing. In contrast, the acid suppressing effect of rabeprazole is not augmented by preprandial administration.


Asunto(s)
Esomeprazol/administración & dosificación , Ayuno , Concentración de Iones de Hidrógeno/efectos de los fármacos , Periodo Posprandial , Inhibidores de la Bomba de Protones/administración & dosificación , Rabeprazol/administración & dosificación , Estómago/efectos de los fármacos , Adulto , Estudios Cruzados , Esomeprazol/farmacología , Femenino , Ácido Gástrico , Determinación de la Acidez Gástrica , Voluntarios Sanos , Humanos , Masculino , Inhibidores de la Bomba de Protones/farmacología , Rabeprazol/farmacología , Adulto Joven
2.
Nihon Rinsho ; 74(8): 1322-1327, 2016 08.
Artículo en Japonés | MEDLINE | ID: mdl-30562436

RESUMEN

Reflux esophagitis is increasing in Japan in association with cultural and societal changes to a more Western lifestyle. The major cause is reflux of gastric contents, consisting mainly of gastric acid, into the esophagus. For prevention, it is necessary to give attention to the contents of meals, as well as food form and eating habits. More specifically, it is important to improve lifestyle habits related to diet, such as refraining from ingesting foods that stimu- late gastric acid secretion or promote relaxation of the lower esophageal sphincter, which delays gastric emptying. Furthermore, consuming large meals quickly, lying down immediately after eating, and eating solids, each of which delays gastric emptying, should be avoided, as well as acidic foods and hot meals.


Asunto(s)
Esofagitis Péptica , Conducta Alimentaria , Reflujo Gastroesofágico , Dieta , Esofagitis Péptica/dietoterapia , Esofagitis Péptica/etiología , Reflujo Gastroesofágico/dietoterapia , Reflujo Gastroesofágico/etiología , Humanos , Estilo de Vida
3.
Nihon Rinsho ; 73(7): 1086-92, 2015 Jul.
Artículo en Japonés | MEDLINE | ID: mdl-26165062

RESUMEN

In association with significant alterations in lifestyle habits, such as more Westernized dietary habits, and environmental factors including improved hygiene, changes in gastric acid secretion and upper gastrointestinal motility have recently been noted in Japanese individuals. Formerly, peptic ulcers, especially those caused by Helicobacter pylori infection, was the major acid-related disease encountered in Japan. However, more recently, cases of NSAID--and aspirin-induced ulcers are increasing. In addition, gastroesophageal reflux disease causing heartburn associated with reflux of stomach contents, mainly consisting of gastric acid, and functional dyspepsia with upper gastrointestinal symptoms, such as indigestion and gastric pain, are more often seen in patients.


Asunto(s)
Conducta Alimentaria , Ácido Gástrico/metabolismo , Distribución por Edad , Gastritis/epidemiología , Humanos , Estilo de Vida
4.
BMC Gastroenterol ; 14: 116, 2014 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-24990161

RESUMEN

BACKGROUND: The incidence and severity of gastroesophageal reflux disease (GERD) in Japan tends to increase in elderly women. Rikkunshito (RKT), a traditional Japanese medicine, acts as a prokinetic agent and improves gastric emptying and gastric accommodation. Our previous prospective randomized placebo-controlled study showed that RKT combined with a standard-dose of rabeprazole (RPZ) significantly improved the acid-related dysmotility symptoms (ARD) in elderly patients with proton pump inhibitor (PPI)-refractory non-erosive reflux disease (NERD). This study aimed to evaluate clinical characteristics of elderly PPI-refractory NERD patients with ARD symptoms who responded to RKT. METHODS: Two hundred forty-two patients with PPI-refractory NERD were randomly assigned to 8 weeks of either RPZ (10 mg/q.d.) + RKT (7.5 g/t.i.d.) (RKT group) or RPZ + placebo (PL group). Among them, 95 were elderly (≥65 years) with ARD (RKT group: n = 52; PL group: n = 43). We analyzed the changes using the 12 subscale score of frequency scale for the symptoms of GERD (FSSG) and 15 items of the Gastrointestinal Symptom Rating Scale at 4 and 8 weeks and compared the therapeutic efficacy between the 2 groups. RESULTS: There were no marked differences in baseline demographic or clinical characteristics in the 2 groups except for rate of current smoking. The FSSG score (mean ± SD at 0, 4, and 8 weeks) in both the RKT (16.0 ± 7.0; 9.9 ± 8.4; 7.0 ± 6.4) and PL (15.1 ± 6.4; 10.9 ± 6.7, 11.1 ± 8.5) groups significantly decreased after treatment. However, the degree of improvement of total and ARD scores of FSSG after the 8-week treatment was significantly greater in the RKT group than in the PL group. Combination therapy with RKT for 8 weeks showed significant improvement in 3 subscale scores (abdominal bloating, heavy feeling in stomach and sick feeling after meals) of the ARD domain and 1 subscale score (heartburn after meals) of the reflux symptom domain. CONCLUSIONS: RKT may be useful for improving GERD symptoms in elderly PPI-refractory NERD patients with ARD. Thus, RKT was particularly effective for resolving postprandial GERD symptoms (heavy feeling in stomach, sick feeling, and heartburn after meals). TRIAL REGISTRATION: (UMIN000005880).


Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Vaciamiento Gástrico , Reflujo Gastroesofágico/tratamiento farmacológico , Inhibidores de la Bomba de Protones/uso terapéutico , Rabeprazol/uso terapéutico , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Humanos , Japón , Masculino , Insuficiencia del Tratamiento , Resultado del Tratamiento
5.
J Clin Biochem Nutr ; 55(3): 178-83, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25411523

RESUMEN

Comparisons between the acid inhibitory effects of rabeprazole and esomeprazole after single oral administration with standard doses have not been previously presented. We examined intra-gastric pH after oral administrations of these two proton pump inhibitors using 24-h pH monitoring. Fifty-four normal volunteers not infected by Helicobacter pylori were investigated. Using a cross-over design, we administered 10 mg of rabeprazole or 20 mg of esomeprazole in 27 at 30 min after supper and in the remaining 27 subjects at 15 min before supper, and performed 24-h pH monitoring. Intra-gastric pH data were nearly identical when the proton pump inhibitors were taken after meals. Even if the data were compared in different CYP2C19 genotypes, rabeprazole and esomeprazole did not show the difference. In poor metabolizer, both of the drugs showed stronger acid inhibition. When taken before meals, intra-gastric pH after esomeprazole administration was slightly but not significantly higher than that observed after rabeprazole administration not only in daytime but also in nighttime period. In conclusion, rabeprazole and esomeprazole were similarly effective when administered after a meal.

6.
J Gastroenterol Hepatol ; 28(8): 1306-13, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23489221

RESUMEN

BACKGROUND AND AIM: Allergies have been implicated in the pathogenesis of eosinophilic gastrointestinal disorders, although it remains unknown what type of allergen is closely associated with their development. The aim of this study is to investigate the possible involvement of food and/or aeroallergen factors in eosinophilic gastrointestinal disorders. METHODS: Eighteen patients with eosinophilic esophagitis (EoE), 23 with eosinophilic gastroenteritis (EGE), and 28 healthy volunteers were enrolled. The levels of total serum immunoglobulin E (IgE) and 33 different allergen-specific IgE antibodies, including those for six foods used in a standard EoE elimination diet, were determined in each subject. Serum antigen-specific IgE levels were measured using a chemiluminescence enzyme immunoassay with a multiple antigen simultaneous test 33 (MAST33). The expression patterns of specific antigens were compared among the groups. RESULTS: The mean level of total IgE antibodies was significantly higher in patients with EGE (553.6 ± 115.3 IU/mL) than the healthy volunteers (230.6 ± 87.1 IU/mL). Two thirds of all subjects had sensitivity to at least one inhaled antigen. In positive cases, allergies against multiple antigens were more frequently seen in the EoE and EGE patients. Japanese cedar and dust mite aeroallergens were more prevalent than food antigens. CONCLUSIONS: Consistent with higher levels of serum total IgE antibodies, patients with EoE and EGE were frequently sensitized to several different allergens. Reactions to aeroallergens were more prevalent in these groups, although no particular antigen causing EoE and/or EGE was detected by measuring serum antigen-specific IgE antibodies.


Asunto(s)
Alérgenos/inmunología , Enteritis/etiología , Enteritis/inmunología , Eosinofilia/etiología , Eosinofilia/inmunología , Esofagitis Eosinofílica/etiología , Esofagitis Eosinofílica/inmunología , Gastritis/etiología , Gastritis/inmunología , Inmunoglobulina E/sangre , Pruebas Inmunológicas , Adulto , Anciano , Anciano de 80 o más Años , Animales , Cedrus/inmunología , Epítopos , Femenino , Alimentos/efectos adversos , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/inmunología , Humanos , Masculino , Persona de Mediana Edad , Pyroglyphidae/inmunología , Adulto Joven
7.
J Gastroenterol Hepatol ; 28(10): 1600-7, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23663082

RESUMEN

BACKGROUND AND AIM: The function of the lower esophageal sphincter (LES) is evaluated using an esophageal manometric study. However, information regarding the surrounding organs is difficult to obtain with use of a sensor catheter. We investigated the utility of 320-row area detector computed tomography (CT) to evaluate morphological changes of the esophagogastric junction and surrounding organs. METHODS: The study subjects were 18 healthy volunteers and 29 patients with reflux esophagitis (RE). Immediately after swallowing a diluted contrast agent, continuous imaging of the esophagogastric junctional area was performed for 15 s. Using CT images, the presence or absence of esophageal hiatal hernia, His angle before and after swallowing, size of the diaphragmatic hiatus, morphologically identified-LES (MI-LES) length, intraluminal horizontal area of MI-LES during relaxation phase, MI-LES thickness, abdominal esophagus length, subcutaneous fat area, visceral fat area, and esophagogastric junction fat area were evaluated. RESULTS: Analysis of CT images showed more frequent occurrence of hiatal hernia, greater His angle, and a larger diaphragmatic hiatus in patients with severe RE, while the lengths of MI-LES and abdominal esophagus were shorter in those patients. Visceral and esophagogastric junction fat areas tended to be greater in patients with RE. In all subjects, the posterior wall of the MI-LES was thicker than the anterior wall. CONCLUSION: Continuous imaging with 320-row area detector CT is useful to evaluate morphological changes in the esophagogastric junction area in both normal individuals and patients with reflux esophagitis.


Asunto(s)
Esofagitis Péptica/diagnóstico por imagen , Unión Esofagogástrica/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Anciano , Deglución/fisiología , Esfínter Esofágico Inferior/patología , Esfínter Esofágico Inferior/fisiopatología , Esofagitis Péptica/complicaciones , Unión Esofagogástrica/patología , Unión Esofagogástrica/fisiopatología , Estudios de Factibilidad , Femenino , Hernia Hiatal/complicaciones , Hernia Hiatal/diagnóstico por imagen , Humanos , Masculino , Manometría , Persona de Mediana Edad , Adulto Joven
8.
J Clin Biochem Nutr ; 53(1): 60-2, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23874072

RESUMEN

Recent studies have suggested that decrease in Helicobacter pylori infection may predispose to allergic diseases. However, there are few reports of the relationships of eosinophilic gastrointestinal disorders (EGIDs), especially eosinophilic gastroenteritis (EGE), with H. pylori infection. We investigated the possible influence of H. pylori infection on EGIDs in Japanese patients. We performed a case-control study to investigate the prevalence of H. pylori infection in patients with EGIDs. Eighteen with eosinophilic esophagitis (EoE) and 22 with EGE were enrolled. For each patient, 3 age- and gender-matched normal controls (n = 120) were randomly selected from a population who received a medical check-up between April 2010 and December 2011 at the Shimane Institute of Health Science. The mean ages of the EoE and EGE patients were 50.9 ± 17 and 49.2 ± 20 years, respectively. Males were more frequently seen in the EoE group, while there was no significant gender difference in regard to EGE. Of the patients with EoE, 22.3% were infected with H. pylori, as compared to 55.5% of their age- and sex-matched normal controls. The odds ratio for EoE patients to have an H. pylori infection was 0.22 (p<0.05). In addition, 22.7% of the patients with EGE and 48.5% of their matched controls were infected with H. pylori, with odds ratio for EGE patients to have an H. pylori infection shown to be 0.31 (p<0.05). In conclusion, the prevalence of H. pylori infection was significantly lower in EGE and EoE patients in Japan as compared to normal control subjects.

9.
J Gastroenterol Hepatol ; 27(5): 899-906, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22098590

RESUMEN

BACKGROUND AND AIM: We aimed to determine whether reflux- and symptom-related parameters can predict the efficacy of proton pump inhibitors (PPI) in non-erosive reflux disease (NERD). METHODS: Twenty-seven NERD patients who had experienced heartburn more than once a week within the previous month were enrolled. Intraesophageal pH before therapy was measured simultaneously at 5 and 15 cm above the esophagogastric junction (EGJ) for 24 h. The PPI rabeprazole was administered at a dose of 10 mg once daily for 4 weeks. In the event that heartburn was not relieved, the dose was increased to 10 mg twice daily for an additional 2 weeks, and again to 20 mg twice daily for another 2 weeks. RESULTS: Univariate analysis demonstrated no significant associations between any reflux- or symptom-related parameters at either site and complete heartburn relief after 4 weeks, or cumulative complete heartburn relief after 8 weeks. However, post-hoc analysis demonstrated more satisfactory heartburn relief after 4 weeks in patients with a high symptom index compared with those with a low symptom index, at 5 cm above the EGJ (P = 0.009). Cumulative satisfactory heartburn relief after 8 weeks was also greater in patients with a high total number of acid reflux episodes compared with those with a low total number of episodes, at 15 cm above the EGJ (P = 0.037). CONCLUSIONS: Pre-therapeutic pH monitoring in the lower and mid-esophagus is useful for predicting the efficacy of PPI in NERD patients.


Asunto(s)
2-Piridinilmetilsulfinilbencimidazoles/uso terapéutico , Monitorización del pH Esofágico , Reflujo Gastroesofágico/tratamiento farmacológico , Pirosis/tratamiento farmacológico , Inhibidores de la Bomba de Protones/uso terapéutico , Adolescente , Adulto , Distribución de Chi-Cuadrado , Femenino , Reflujo Gastroesofágico/complicaciones , Pirosis/etiología , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Valor Predictivo de las Pruebas , Rabeprazol , Índice de Severidad de la Enfermedad , Adulto Joven
10.
Digestion ; 86(3): 238-43, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22964662

RESUMEN

BACKGROUND/AIM: The role of Th2-type cytokines in development of eosinophilic esophagitis (EoE) has been largely revealed, whereas research on the pathogenesis of eosinophilic gastroenteritis (EGE) has not been widely performed. We investigated the possible involvement of Th2-type cytokines in EGE by measuring plasma cytokine concentrations in patients with EGE as well as those with EoE. METHODS: 18 patients with EoE, 18 with EGE, and 30 normal volunteers were enrolled in the study. Plasma concentrations of five cytokines (thymic stromal lymphopoietin, IL-5, IL-13, IL-15, and eotaxin-3) were measured using Milliplex assays. Clinical characteristics of the patients and plasma cytokine levels were then compared. RESULTS: Higher proportions of patients with EoE and those with EGE showed elevated plasma concentrations of IL-5 and IL-15 as compared to the normal controls. There was also a positive correlation between IL-5 and IL-15, and also with blood eosinophil count. The plasma concentrations of these cytokines tended to be higher in cases with EGE than in those with EoE, though there were overlaps in cytokine levels among the patients and controls. CONCLUSION: Similar increases in plasma IL-5 and IL-15 were observed in patients with EoE and those with EGE.


Asunto(s)
Citocinas/sangre , Enteritis/sangre , Eosinofilia/sangre , Esofagitis Eosinofílica/sangre , Gastritis/sangre , Gastroenteritis/sangre , Biomarcadores/sangre , Enteritis/epidemiología , Eosinofilia/epidemiología , Esofagitis Eosinofílica/epidemiología , Femenino , Gastritis/epidemiología , Gastroenteritis/epidemiología , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia
11.
Dig Dis Sci ; 57(6): 1609-17, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22367114

RESUMEN

BACKGROUND AND AIM: Reflux symptoms in patients with non-erosive reflux disease (NERD) cannot be easily controlled by treatment with proton pump inhibitors (PPI). The anti-inflammatory function of rebamipide may be effective for protecting the esophageal mucosa. This prospective randomized multicenter placebo-controlled study was performed to clarify the efficacy of rebamipide for NERD patients whose reflux symptoms were refractory to PPI treatment. METHODS: One hundred forty-nine patients were enrolled on the basis of a QUEST score of over 6 and absence of endoscopically proven esophageal mucosal breaks. All the patients were initially administered 15 mg of lansoprazole for 4 weeks, and the symptoms were then assessed using QUEST and GSRS. PPI-refractory patients were randomly assigned to administration of rebamipide or placebo t.i.d. for 4 weeks. RESULTS: Three of the 149 patients were lost to follow-up, and 60 among the remaining 146 patients were found to be PPI-refractory. Among these PPI-refractory patients, 31 were randomly assigned to a rebamipide group and 29 to a placebo group. At the end of drug administration, the QUEST and GSRS scores did not differ between the rebamipide and placebo groups, although a significantly higher proportion of patients in the rebamipide group showed amelioration of abdominal pain and diarrhea. CONCLUSION: Administration of rebamipide cannot effectively control reflux symptoms in NERD patients whose symptoms are refractory to PPI therapy.


Asunto(s)
2-Piridinilmetilsulfinilbencimidazoles/uso terapéutico , Alanina/análogos & derivados , Resistencia a Medicamentos , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/tratamiento farmacológico , Inhibidores de la Bomba de Protones/uso terapéutico , Quinolonas/uso terapéutico , 2-Piridinilmetilsulfinilbencimidazoles/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Alanina/uso terapéutico , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Monitorización del pH Esofágico , Esofagoscopía/métodos , Femenino , Estudios de Seguimiento , Humanos , Lansoprazol , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Inhibidores de la Bomba de Protones/efectos adversos , Recurrencia , Valores de Referencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Resultado del Tratamiento , Adulto Joven
12.
Curr Ther Res Clin Exp ; 73(3): 112-20, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24648598

RESUMEN

BACKGROUND: The number of patients who require treatment with proton pump inhibitors (PPIs) is increasing in Japan. One of their adverse effects is diarrhea. OBJECTIVES: We investigated the incidence of diarrhea caused by 3 different PPIs: lansoprazole, rabeprazole, and omeprazole. METHODS: Patients using PPIs for >1 month were enrolled. Enrolled patients recorded daily stool frequency, stool consistency using the Bristol Stool Scale Form, and impaired quality of life caused by diarrhea for 1 month. Their attending physicians described the types and dosages, and duration of PPI administration, as well as other necessary information. RESULTS: A total of 255 patients participated. Mean age of the patients was 70.7 years old. During the 1-month observation period, 3.5% of the patients complained of diarrhea. There was no significant difference for the incidence of diarrhea among the 3 types of PPIs. Furthermore, no correlations between diarrhea and length and dosage of PPI administration were found. CONCLUSIONS: The incidence of diarrhea in patients receiving long-term therapy did not differ among 3 different PPIs. ClinicalTrials.gov identifier: UMIN ID 000005300.

13.
J Gastroenterol Hepatol ; 26(6): 1060-4, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21362046

RESUMEN

BACKGROUND AND AIM: Many types of food have been shown to affect lower esophageal sphincter pressure and esophageal motor function, and thus, the prevalence of reflux esophagitis. The present study was performed to clarify the different eating habits that predominantly affect the prevalence of reflux esophagitis in Japanese. METHODS: The study included 2303 individuals (males: 1599, females: 704, mean age: 49.9 years) who underwent upper gastrointestinal endoscopy for gastric cancer screening. The daily dietary contents of the patients were analyzed using a self-administered questionnaire. RESULTS: A total of 201 patients had endoscopically-proven reflux esophagitis, and the percentage of males with reflux esophagitis was significantly higher than their female counterparts (11.3% vs 2.8%). The body mass indexes of individuals with reflux esophagitis were significantly higher than those without, both for males and females. Total energy intake was the most important risk factor for the occurrence of reflux esophagitis in males, but the food content was not a significant risk factor. Dietary habit did not affect the prevalence of reflux esophagitis in the female patients. The age and height of females with reflux esophagitis significantly exceeded those of females without reflux esophagitis, and were independent risk factors for the occurrence of reflux esophagitis only in the female patients. CONCLUSION: There is a sex-related difference in the influence of eating habits on the prevalence of reflux esophagitis in Japanese.


Asunto(s)
Pueblo Asiatico/estadística & datos numéricos , Esofagitis Péptica/etnología , Conducta Alimentaria/etnología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estatura/etnología , Distribución de Chi-Cuadrado , Endoscopía Gastrointestinal , Ingestión de Energía/etnología , Esofagitis Péptica/diagnóstico , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Encuestas y Cuestionarios
14.
J Gastroenterol Hepatol ; 26(1): 98-103, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21175801

RESUMEN

BACKGROUND AND AIM: To clarify the usefulness of a newly designed method for measuring intraduodenal pH to examine the relationship between duodenal acidity and upper gastrointestinal symptoms during intragastric acid infusion. METHODS: The study subjects were six healthy volunteers. A Bravo pH capsule with thread fixed to the gastric wall was endoscopically introduced into the second portion of the duodenum, and intraduodenal acidity was measured during intragastric infusion of 300 mL of 0.1 mol/L hydrochloric acid or pure water through an elemental diet tube. The severity of several upper gastrointestinal symptoms were assessed by using a 10-cm visual analogue scale every 2 min for up to 30 min, and the area under the severity scale-time curve (cm×min.) were calculated. RESULTS: The percentage time during 30 min when the intraduodenal pH was <4.0 and was significantly greater than during water infusion (61.4±6.1% vs 24.8±6.5%). Several upper gastrointestinal symptoms were observed during acid infusion (acid vs water epigastric heaviness, 29.1±12.0 vs 2.7±1.4; dull epigastric pain, 8.8±4.9 vs 0.7±0.7 cm×min/30 min). Intraduodenal pH below 4.0 was correlated with the severity of dull pain in the stomach (R(2)=0.342, P=0.044). CONCLUSION: The newly designed intraduodenal pH monitoring by using catheterless radiotelemetry system is useful to examine the relationship between duodenal acidity and upper gastrointestinal symptoms.


Asunto(s)
Dolor Abdominal/diagnóstico , Endoscopía Capsular , Duodenoscopía , Duodeno/metabolismo , Dispepsia/diagnóstico , Monitoreo Fisiológico/métodos , Telemetría , Dolor Abdominal/inducido químicamente , Endoscopios en Cápsulas , Endoscopía Capsular/instrumentación , Estudios Cruzados , Duodenoscopía/instrumentación , Dispepsia/inducido químicamente , Femenino , Humanos , Ácido Clorhídrico/administración & dosificación , Concentración de Iones de Hidrógeno , Bombas de Infusión , Japón , Masculino , Monitoreo Fisiológico/instrumentación , Dimensión del Dolor , Valor Predictivo de las Pruebas , Índice de Severidad de la Enfermedad , Telemetría/instrumentación , Factores de Tiempo , Adulto Joven
15.
Lab Invest ; 90(7): 1033-48, 2010 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-20351696

RESUMEN

The molecular basis of attaining columnar phenotype in Barrett's esophagus is poorly understood. One hypothesis states that factors locally produced by cells of mesenchymal origin in chronic reflux esophagitis induce metaplastic transformation. This study was performed to elucidate the factors secreted from fibroblasts that cause columnar phenotype in adjacent squamous epithelium. Human fibroblast cells were exposed to acidified medium for 20 min, followed by medium neutralization for 2 h, and then total RNA was hybridized to Sentrix Human-6 Expression BeadChips. Furthermore, esophageal mucosal biopsy specimens from reflux esophagitis patients were examined for HB-EGF expression using immunohistochemistry. In addition, cells from the human esophageal squamous epithelial cell line HET1A were treated with recombinant HB-EGF, and changes in expressions of Cdx2 and columnar markers were analyzed. The gene expression profile revealed significant upregulation of a variety of growth factors and inflammatory chemokines in response to acid exposure. Among them, HB-EGF was upregulated more than 10-fold. Biopsy specimens from reflux esophagitis patients showed a strong expression of HB-EGF in fibroblast cells underlying the damaged epithelium. Furthermore, in vitro stimulation of HET1A cells with HB-EGF increased Cdx2 in dose-dependent manners. Functional analysis of human Cdx2 promoter also revealed its upregulation by HB-EGF stimulation, showing the role of potential responsive elements (AP-1 and NF-kappaB) for its transcriptional activation. Moreover, the columnar markers cytokeratin 7 and villin were also upregulated by HB-EGF stimulation. HB-EGF induces several genes characteristics of columnar phenotypes of esophageal squamous epithelium in a paracrine manner.


Asunto(s)
Esófago de Barrett/metabolismo , Fibroblastos/metabolismo , Proteínas de Homeodominio/metabolismo , Péptidos y Proteínas de Señalización Intercelular/metabolismo , Esófago de Barrett/patología , Factor de Transcripción CDX2 , Línea Celular Tumoral , Supervivencia Celular , Citocinas/metabolismo , Esofagitis Péptica/metabolismo , Esófago/metabolismo , Esófago/patología , Fibroblastos/patología , Ácido Gástrico/fisiología , Factor de Crecimiento Similar a EGF de Unión a Heparina , Humanos , Metaplasia , Comunicación Paracrina
16.
J Gastroenterol Hepatol ; 25(6): 1066-71, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20594220

RESUMEN

BACKGROUND AND AIM: A substantial number of patients with gastroesophageal reflux disease show symptomatic resistance to high-dose proton pump inhibitors. In those cases, prokinetics are possible candidates for treatment. The aim of the present study was to determine whether mosapride, a prokinetic agent, stimulates esophageal functions, and prevents acidic and non-acidic gastroesophageal reflux. METHODS: Normal volunteers (nine and 13 for two experiments, respectively) were enrolled. Salivary secretion, esophageal peristaltic contractions, and resting lower esophageal sphincter pressure with and without mosapride administration were recorded using a cross-over protocol. Post-prandial acidic and non-acidic reflux levels were also recorded. RESULTS: Mosapride at a standard dose of 15 mg/day did not stimulate salivary secretion or any esophageal motor functions. It also failed to prevent acidic and non-acidic post-prandial gastroesophageal reflux. CONCLUSIONS: Mosapride at 15 mg/day, a standard dose in Japan, did not change the esophageal motility and salivary secretion in healthy volunteers. Future study on a larger number of individuals with higher dose of mosapride is worthwhile.


Asunto(s)
Benzamidas/administración & dosificación , Esófago/efectos de los fármacos , Reflujo Gastroesofágico/prevención & control , Morfolinas/administración & dosificación , Peristaltismo/fisiología , Agonistas de Receptores de Serotonina/administración & dosificación , Adulto , Antiulcerosos , Estudios Cruzados , Relación Dosis-Respuesta a Droga , Impedancia Eléctrica , Esfínter Esofágico Inferior/efectos de los fármacos , Esfínter Esofágico Inferior/fisiopatología , Monitorización del pH Esofágico , Esófago/metabolismo , Esófago/fisiopatología , Estudios de Seguimiento , Reflujo Gastroesofágico/metabolismo , Reflujo Gastroesofágico/fisiopatología , Humanos , Masculino , Manometría , Peristaltismo/efectos de los fármacos , Presión , Pronóstico , Valores de Referencia , Saliva/metabolismo
17.
Nihon Rinsho ; 68(4): 757-63, 2010 Apr.
Artículo en Japonés | MEDLINE | ID: mdl-20387571

RESUMEN

The Japanese Society of Gastroenterology recently published a GERD guideline that is developed mainly on the published high level evidences. According to the guideline, (1) treatment with a proton pump inhibitor(PPI) even before an endoscopic study, (2) adjustments of dose and way of administration of PPI if a previous standard PPI therapy fails, (3) pH monitoring study if dose adjustment and way of administration of PPIs fails, are recommended for the treatment of GERD. In addition, for the long-term therapy of GERD, PPI maintenance therapy is safe and recommended in the guideline. Regular renewal and revision of the GERD guideline is expected.


Asunto(s)
Reflujo Gastroesofágico/terapia , Humanos , Japón , Guías de Práctica Clínica como Asunto
18.
J Gastroenterol ; 44(8): 812-8, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19526190

RESUMEN

Several components of the gastrointestinal tract including the esophagogastric junction (EGJ) show circumferential asymmetry in the formation of pathological lesions, which is caused by the morphological and functional asymmetry of the gastrointestinal tract. Pressure in the lower esophageal sphincter (LES) is higher on the left posterior side as compared to the right anterior side, which may partly explain why Mallory-Weiss tears frequently occur on the right side wall of the EGJ. Lower LES pressure in the right anterior wall may not effectively prevent gastroesophageal reflux on this side and may be a reason why esophageal erosions in patients with reflux esophagitis, short segment Barrett's esophagus, and adenocarcinomas associated with short segment Barrett's esophagus are frequently found in the right anterior wall of the esophagus. In addition, acidic gastroesophageal reflux may also cause rupture of esophageal varices predominantly on that side. Thus, asymmetrical LES pressure may be a cause of the right anterior side predominance of diseases found in this part of the gastrointestinal tract.


Asunto(s)
Esfínter Esofágico Inferior/patología , Unión Esofagogástrica/patología , Enfermedades Gastrointestinales/fisiopatología , Esfínter Esofágico Inferior/anatomía & histología , Unión Esofagogástrica/anatomía & histología , Reflujo Gastroesofágico/etiología , Reflujo Gastroesofágico/fisiopatología , Enfermedades Gastrointestinales/etiología , Humanos
19.
Digestion ; 80(2): 119-28, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19641321

RESUMEN

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is a common gastrointestinal disease. This study was designed to examine current epidemiology, diagnosis, management, and treatment of patients diagnosed with GERD by surveying physicians in several East Asian countries. METHODS: A questionnaire-based survey was completed in six countries including China, Indonesia, Japan, Korea, the Philippines, and Thailand between July 2008 and December 2008. RESULTS: In total, 876 physicians participated in the study. Most physicians in all countries, except Japan, frequently used international guidelines for the care of GERD patients, whereas approximately half of Japanese physicians did not use such guidelines. GERD was common among many patients, but Barrett's esophagus, particularly the long-segmental type, was rare. The incidence of esophageal cancer, particularly adenocarcinoma, was high in China, but low in other countries. Most physicians diagnosed GERD based on symptoms, followed by endoscopy in Japan and Korea, or in other countries, by the proton-pump inhibitor (PPI) test. Heartburn was recognized as the chief complaint in all countries except Korea. Most physicians in all countries used PPI as the first-line of treatment for GERD. Increasing the PPI dose was the treatment of choice for PPI-refractory erosive esophagitis in Korea, the Philippines, and Thailand. In contrast, in other countries, physicians used a combination of PPI and other drugs to treat PPI-refractory erosive esophagitis. Prescription of antidepressant drugs increased for PPI-refractory nonerosive reflux disease compared with PPI-refractory erosive esophagitis. CONCLUSION: The findings in the present survey are useful to understand the current epidemiology, diagnosis, and treatment of GERD in East Asian countries.


Asunto(s)
Reflujo Gastroesofágico , Médicos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Actitud del Personal de Salud , Asia Oriental/epidemiología , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/epidemiología , Reflujo Gastroesofágico/terapia , Adhesión a Directriz/estadística & datos numéricos , Encuestas de Atención de la Salud , Humanos , Guías de Práctica Clínica como Asunto , Encuestas y Cuestionarios
20.
Digestion ; 79(3): 177-85, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19342858

RESUMEN

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin are widely used clinically but increase the risk of gastrointestinal (GI) complications. AIM: To examine the current prescription of NSAIDs and comedication to prevent GI complications from NSAIDs within East Asia by means of a questionnaire survey. METHODS: Representative members of the Committee of the International Gastrointestinal Consensus Symposium provided a questionnaire to physicians in 6 East Asian countries. RESULTS: A total of 1,568 physicians participated in this survey. Most physicians prescribed nonselective NSAIDs, cyclooxygenase-2 inhibitors (COXIBs) or aspirin for more than 5 patients per week in all countries, with the exception of the prescription of COXIBs in Japan. Of the nonselective NSAIDs, the drug most frequently prescribed as a first choice was loxoprofen (34%), which was mainly prescribed in Japan, followed by diclofenac (30%). The frequency of prescription of comedication with nonselective NSAIDs was higher compared with that for selective COXIBs or aspirin. Physicians in the northern region (China, Japan and Korea) preferred mucoprotective drugs for comedication with NSAIDs or aspirin, while those in southern region (Indonesia, Philippines and Thailand) frequently used proton-pump inhibitors. CONCLUSION: Among East Asian countries, there are both similarities and differences in the prescription of NSAIDs and of comedication to prevent GI complications.


Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Pautas de la Práctica en Medicina , Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/efectos adversos , Aspirina/uso terapéutico , Asia Oriental , Femenino , Humanos , Masculino , Encuestas y Cuestionarios
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA