RESUMEN
BACKGROUND AND AIM: The risk for erosive esophagitis (EE) with low-dose aspirin (ASA) remains unknown, especially among Japanese patients. We conducted the present study to compare the risk of EE with that of gastroduodenal mucosal injury among Japanese patients taking ASA. METHODS: From 5555 patients undergoing upper gastrointestinal endoscopy from January 2005 to December 2006 at Teikyo University Hospital, Tokyo, Japan, 159 patients (76 males and 83 females, mean age: 69.3 +/- 11 years) fulfilling the following conditions were selected: (i) taking ASA (less than 100 mg/day) continuously; (ii) not taking acid suppressants; and (iii) no history of gastrointestinal tract surgery, malignancies, severe cardiac failure, or liver cirrhosis. Age- and sex-matched patients not taking aspirin were randomly chosen as controls (n = 159). Two well-experienced endoscopic examiners evaluated endoscopic records to determine the presence or absence of esophageal hiatal hernia, EE, and gastroduodenal ulcers. RESULTS: The prevalence of EE in patients taking aspirin (9.4%) was not different from that of the controls (6.3%, odds ratio [OR]: 1.5, 95% confidence interval [CI]: 0.7-3.2), whereas peptic ulcers were found more frequently in the aspirin group (14%) than in the control group (4%, OR: 3.6, 95% CI: 1.5-8.8). CONCLUSION: In Japanese patients taking ASA, EE was not as common as peptic ulcers.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Pueblo Asiatico/estadística & datos numéricos , Aspirina/efectos adversos , Esofagitis/inducido químicamente , Esofagitis/etnología , Úlcera Péptica/inducido químicamente , Úlcera Péptica/etnología , Anciano , Antiinflamatorios no Esteroideos/administración & dosificación , Aspirina/administración & dosificación , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Endoscopía Gastrointestinal , Esofagitis/patología , Femenino , Mucosa Gástrica/efectos de los fármacos , Mucosa Gástrica/patología , Humanos , Mucosa Intestinal/efectos de los fármacos , Mucosa Intestinal/patología , Japón/epidemiología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Úlcera Péptica/patología , Prevalencia , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND AND OBJECTIVE: Recent studies have indicated that rabeprazole, a proton pump inhibitor, delays gastric emptying. However, the mechanism of action remains unclear. We conducted this study to clarify whether desacyl-ghrelin (the inactive form of the endogenous growth hormone secretagogue receptor ghrelin) is involved in rabeprazole-induced changes in gastric motor function. METHODS: Twelve healthy males underwent (13)C-acetate breath tests to evaluate gastric emptying of a liquid meal twice after administration of rabeprazole 20 mg/day for 3 days or no medication (control). Gastric emptying was evaluated by two parameters: half-emptying time and time to peak (13)CO(2) excretion. Plasma desacyl-ghrelin levels were measured in blood samples collected at three time points: immediately pre-test and 1 and 2 hours after ingestion of the test meal. RESULTS: Rabeprazole significantly delayed gastric emptying of the liquid meal. However, plasma desacyl-ghrelin levels after ingestion of the liquid meal showed little difference before or after rabeprazole administration. CONCLUSION: The results indicate that desacyl-ghrelin was not associated with changes in gastric emptying caused by rabeprazole.
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2-Piridinilmetilsulfinilbencimidazoles/farmacocinética , Vaciamiento Gástrico/efectos de los fármacos , Ghrelina/sangre , 2-Piridinilmetilsulfinilbencimidazoles/administración & dosificación , 2-Piridinilmetilsulfinilbencimidazoles/sangre , Administración Oral , Adulto , Pruebas Respiratorias/métodos , Dióxido de Carbono/análisis , Dióxido de Carbono/metabolismo , Isótopos de Carbono , Vaciamiento Gástrico/fisiología , Gastrinas/sangre , Gastrinas/química , Ghrelina/química , Semivida , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de la Bomba de Protones/administración & dosificación , Inhibidores de la Bomba de Protones/sangre , Inhibidores de la Bomba de Protones/farmacocinética , Rabeprazol , Estadísticas no ParamétricasRESUMEN
BACKGROUND: Keratinocytes release several factors that are involved in wound contracture and scar formation. We previously reported that a three-dimensional reconstruction model derived from rat skin represents a good wound healing model. OBJECTIVE: We characterized the role of transient receptor potential (TRP) channels in the release of transforming growth factor (TGF)-ß1 from keratinocytes and the differentiation of fibroblasts to identify possible promising pharmacological approaches to prevent scar formation and contractures. METHODS: The three-dimensional culture model was made from rat keratinocytes seeded on a collagen gel in which dermal fibroblasts had been embedded. RESULTS: Among the TRP channel inhibitors tested, the TRPV2 inhibitors SKF96365 and tranilast attenuated most potently keratinocyte-dependent and - independent collagen gel contraction due to TGF-ß signaling as well as TGF-ß1 release from keratinocytes and α-smooth muscle actin production in myofibroblasts. Besides the low amounts detected in normal dermis, TRPV2 mRNA and protein levels were increased after fibroblasts were embedded in the gel. TRPV2 was also expressed in the epidermis and keratinocyte layers of the model. Both inhibitors and TRPV2 siRNA attenuated the intracellular increase of Ca2+ induced by the TRPV agonist 2-aminoethoxydiphenyl borate in TGF-ß1-pretreated fibroblasts. CONCLUSION: This is the first study to show that compounds targeting TRPV2 channels ameliorate wound contraction through the inhibition of TGF-ß1 release and the differentiation of dermal fibroblasts in a culture model.
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Diferenciación Celular/efectos de los fármacos , Miofibroblastos/fisiología , Canales Catiónicos TRPV/antagonistas & inhibidores , Factor de Crecimiento Transformador beta1/metabolismo , Cicatrización de Heridas/efectos de los fármacos , Actinas/metabolismo , Animales , Compuestos de Boro/farmacología , Células Cultivadas , Células Epidérmicas , Epidermis/efectos de los fármacos , Epidermis/fisiología , Queratinocitos/efectos de los fármacos , Queratinocitos/metabolismo , Miofibroblastos/efectos de los fármacos , Cultivo Primario de Células , ARN Mensajero/metabolismo , ARN Interferente Pequeño/metabolismo , Ratas , Ratas Wistar , Canales Catiónicos TRPV/genética , Canales Catiónicos TRPV/metabolismoRESUMEN
A urinary test for detecting the anti-H. pylori antibody using immunochromatography (RAPIRAN) is considered suitable for the screening purpose. However, this may yield spurious results in the presence of proteinuria. The present study was conducted to evaluate the diagnostic performance of RAPIRAN in patients with proteinuria. Urine and serum samples of adult inpatients with proteinuria were used for analyses. The diagnosis of H. pylori infection was made based on the seropositivity of anti-H. pylori antibody using 2 different serum tests. Fifty-one subjects were eligible for analyses. The serum tests showed negative and positive in 25 and 26 patients, respectively. Two of 25 seropositive patients had a negative result in RAPIRAN, and 1 provided invalid data. All of seronegative patients showed negative in RAPIRAN. The overall accuracy was 95.0%. The present study showed that RAPIRAN has diagnostic quality enough to use clinically also in patients with proteinuria.
Asunto(s)
Anticuerpos Antibacterianos/orina , Cromatografía de Afinidad/métodos , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori/inmunología , Proteinuria/complicaciones , Adulto , Femenino , Infecciones por Helicobacter/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
AIM: Although the quality of currently available urinary tests for detecting antibody to Helicobacter pylori (H pylori) have been proved in some populations, the accuracy has not been studied regarding patients who suffer from pulmonary tuberculosis with multi-drug treatments. The present study was conducted to evaluate the accuracy of these urinary tests for antibody to H pylori in these patients. METHODS: Serum samples from 61 inpatients with pulmonary tuberculosis were tested using enzyme immunoassay, and urine samples were assayed by enzyme-linked immunosorbent assay method (URINELISA) and immunochromatography method (RAPIRAN). Medicines prescribed to the patients were recorded for medical charts, to evaluate the influences on the results of urinary tests. RESULTS: The sensitivity, specificity, and consistency of URINELISA against the serum test were 93.1%, 65.6%, and 78.6% respectively, and those of RAPIRAN were 86.2%, 93.7%, and 90.1% respectively, which were almost equal to the data previously reported. Prescribed medicines had little influence on the results. CONCLUSION: The two urinary tests for detecting H pylori antibody have a diagnostic accuracy in patients with pulmonary tuberculosis given multiple anti-tuberculosis drugs.
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Antituberculosos/uso terapéutico , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/orina , Helicobacter pylori , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Infecciones por Helicobacter/sangre , Infecciones por Helicobacter/complicaciones , Helicobacter pylori/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Orina/microbiologíaAsunto(s)
Antidepresivos de Segunda Generación/efectos adversos , Endoscopía Gastrointestinal , Mucosa Gástrica/efectos de los fármacos , Hemorragia Gastrointestinal/inducido químicamente , Mucosa Intestinal/efectos de los fármacos , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Duodeno/efectos de los fármacos , Duodeno/patología , Femenino , Mucosa Gástrica/patología , Humanos , Mucosa Intestinal/patología , Masculino , Persona de Mediana EdadRESUMEN
The associations between smoking, alcohol intake and peptic ulcer have been investigated not a few. And it is obvious that smoking aggravate peptic ulcers. With increasing age the percentage of smoker decrease, however, 49.2 percent of men at ages over 70 still smoke in Japan. Giving up smoking is important in the prevention of peptic ulcers. On the other hand, it is not regarded that peptic ulcers are correlated with alcohol intake. But alcohol intake causes the acute injury of the gastric mucosa. It seems that moderate drinking is important in the prevention of peptic ulcers, especially in the elderly.
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Consumo de Bebidas Alcohólicas/epidemiología , Úlcera Péptica/epidemiología , Fumar/epidemiología , Anciano , Consumo de Bebidas Alcohólicas/efectos adversos , Femenino , Humanos , Masculino , Úlcera Péptica/etiología , Úlcera Péptica/prevención & control , Fumar/efectos adversosAsunto(s)
Enfermedades Gastrointestinales/inducido químicamente , Inhibidores de Agregación Plaquetaria/efectos adversos , Anciano , Anciano de 80 o más Años , Quimioterapia Combinada , Duodeno/patología , Endoscopía Gastrointestinal , Femenino , Mucosa Gástrica/patología , Enfermedades Gastrointestinales/patología , Hemorragia/inducido químicamente , Humanos , Mucosa Intestinal/patología , Japón/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
A 90-year-old woman visited to our institute due to postprandial obstructive sensation of the esophagus. She had suffered from ischemic heart disease and diabetes mellitus, and taken low-dose aspirin for prophylaxis. She also had a history of a large ulcer located on the upper gastric body at 81 years-old. Esophago-gastric junction was normal excepting mild hiatal hernia at that time. The esophagogastroduodenoscopy showed a lump of food at the lower esophagus with severe stricture and mucosal injury. Rabeprazole 20 mg per day was given, and both the inflammatory change and the symptoms improved after the prescription. A probable reason of the development is impaired gastroesophageal motility and acid regurgitation induced by gastric deformity caused after ulcer formation.
RESUMEN
A 68 year-old-male with hepatitis C-positive liver cirrhosis was admitted because of liver abscess. After metronidazole was initiated against the infection, mental disturbance appeared. Hepatic encephalopathy was suspected at first, however, the brain MRI showed hyperintense lesion of the bilateral basal dendric nuclei which indicated metronidazole-associated encephalopathy. The symptoms became well after cessation of the drug. Metronidazole is a widely used medicine against various infections. Recent case reports describe that this medicine can induce reversible encephalopathy. However, there have been few reports regarding metronidazole-induced encephalopathy occurred in patients with cirrhosis. Here we report on a case of hepatic cirrhosis and abscess in which reversible metronidazole-induced encephalopathy developed.
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Neoplasias Hepáticas/complicaciones , Neurofibromatosis 1/complicaciones , Somatostatinoma/complicaciones , Biopsia , Diagnóstico Diferencial , Endoscopía Gastrointestinal , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/diagnóstico , Masculino , Persona de Mediana Edad , Neurofibromatosis 1/diagnóstico , Somatostatinoma/diagnóstico , Tomografía Computarizada por Rayos XAsunto(s)
Complejo Mioeléctrico Migratorio , Diálisis Renal , Albúmina Sérica/análisis , Femenino , Humanos , Japón , Masculino , Persona de Mediana EdadRESUMEN
Upper gastrointestinal hemorrhage (UGIH) is an urgent disease that is often encountered in daily medical practice. Endoscopic hemostasis is currently indispensable for the treatment of UGIH. Initially, when UGIH is suspected, a cause of UGIH is presumed from the medical interview and physical findings. After ample primary treatment, urgent endoscopy is performed. Many methods of endoscopic hemostasis are in wide use, including hemoclip, injection and thermo-coagulation methods. Although UGIH develops from a wide variety of diseases, such as esophageal varices and gastric and duodenal ulcer, hemostasis is almost always possible. Identification of the causative diseases, primary treatment and characteristic features of endoscopic hemostasis are needed to allow appropriate treatment.
RESUMEN
The present study was conducted to investigate the prevalence of mucosal injury in patients taking low-dose aspirin in Japan and examine the effect of gastric mucoprotective drugs on aspirin-related gastroduodenal toxicity. We selected 530 patients who had taken low-dose aspirin for 1 month or more after undergoing esophagogastroduodenoscopy from 2005 through 2006 at Teikyo University Hospital, Tokyo, Japan. Endoscopic records were retrospectively reviewed to determine the presence of massive bleeding and mucosal injury (ulcer or erosion). The influence of clinical factors, including co-administration of gastroprotective drugs, was also examined. Hemorrhage was observed in 25 patients (3.7%) and mucosal injury (36.2%) in 192 patients. The presence of Helicobacter pylori antibody was a significant risk factor associated with mucosal injury. Patients taking any gastroprotective drug showed a significantly lower rate of mucosal injury than those not taking these drugs. Patients taking rebamipide concomitantly with proton pump inhibitors or histamine 2 receptor antagonists had mucosal injury less frequently than those taking acid suppressants plus other mucoprotective drugs. In conclusion, these results show the possible gastroprotective effects of rebamipide, suggesting that it may be a good choice in aspirin users with gastroduodenal toxicity that is not suppressed by acid suppressants alone.
RESUMEN
Accurate diagnosis of Helicobacter pylori infection is essential in today's clinical settings. Additionally, because of the widespread prevalence of this infection, noninvasive and convenient techniques are required for screening purposes. RAPIRUN H. pylori antibody detection kit (Otsuka Pharmaceutical Co., Ltd, Tokyo, Japan) enables a diagnosis within 20 min using a random, single-voided urine specimen. Thus it is especially suited for use in point-of-care settings. The sensitivity and specificity are acceptable and comparable with other available methods. Here we provide an overview of the RAPIRUN kit.
Asunto(s)
Anticuerpos Antibacterianos/inmunología , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/inmunología , Inmunoensayo/métodos , Juego de Reactivos para Diagnóstico , Humanos , Inmunoensayo/economía , Sistemas de Atención de PuntoRESUMEN
We report a patient with primary hypothyroidism, who developed hepatocellular injury due to levothyroxine, synthetic thyroxine. A 63-year-old male was admitted to our hospital due to elevation of liver enzymes. The patient was diagnosed as having hypothyroidism and had been treated with levothyroxine for almost two months until admission. Drug-induced liver injury induced due to levothyroxine was suspected and liver enzymes were rapidly decreased after discontinuation of levothyroxine and dried thyroid powder, also containing thyroxine. Synthetic triiodothyronine, the deiodinated form of levothyroxine was administered instead, and was well tolerated by the patient. The drug-induced lymphocyte stimulation test (DLST) using levothyroxine was negative. Since triiodothyronine which structurally resembles levothyroxine did not cause liver injury, and DLST using levothyroxine was negative, it is unlikely that levothyroxine itself was targeted by the immune system. Rather, we assume that the complex of levothyroxine as the hapten and liver-related macromolecules in the body as the carrier might have acquired antigenicity in this patient and subsequently resulted in liver injury.
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Enfermedad Hepática Inducida por Sustancias y Drogas , Hipotiroidismo/tratamiento farmacológico , Tiroxina/efectos adversos , Humanos , Hipotiroidismo/diagnóstico , Hepatopatías/diagnóstico , Hepatopatías/terapia , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Triyodotironina/uso terapéuticoAsunto(s)
Aspirina/efectos adversos , Mucosa Intestinal/efectos de los fármacos , Tetrazoles/uso terapéutico , Aspirina/administración & dosificación , Aspirina/uso terapéutico , Cilostazol , Endoscopía , Femenino , Humanos , Mucosa Intestinal/patología , Masculino , Tetrazoles/administración & dosificación , Tetrazoles/efectos adversosRESUMEN
Splenic cysts are uncommon, and cysts derived from the accessory spleen are rare. We report a case of a huge splenic cyst derived from the accessory spleen in the omentum, concomitant with multiple epithelial cysts of the primary spleen. Both serum and cystic fluid concentrations of carbohydrate antigen (CA)19-9 were markedly elevated. A huge monolocular cyst occupied the entire abdomen. A total of 71 of aspirated cystic fluid was turbid and yellowish-brown. The cyst wall, which consisted of CA19-9-positive squamous epithelium, contained approximately 2 x 3 x 1cm of splenic tissue. There was a separate multicystic 16 x 8-cm spleen in the normal position. The CA19-9 serum level returned to normal postoperatively.
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Quistes/cirugía , Bazo/anomalías , Enfermedades del Bazo/cirugía , Adulto , Antígeno CA-19-9/análisis , Humanos , Masculino , Epiplón/anomalías , Enfermedades del Bazo/metabolismoRESUMEN
This study evaluates the clinical usefulness of titers of antibody to Helicobacter pylori (Hp) in a urine-based enzyme-linked immunosorbent assay (URINELISA; Otsuka Pharmaceutical, Tokushima, Japan) by comparing values of serum antibody to Hp in an already commercialized kit in a population of 250 asymptomatic individuals. Influences of physical and laboratory characteristics on the relationship between serum and urinary titers of antibody to Hp were also estimated using simple and multiple regression analyses. Specific urine gravity, urine pH, proteinuria, and age of the subjects were regarded as significant factors relating to urinary titers of the anti-Hp antibody on simple regression analyses. Both the urinary and serum titers strongly correlated on simple regression analysis (r = 0.782, P < 0.0001). On multiple regression analysis, an additional two factors, specific urine gravity and urine pH, were picked up, and the correlation coefficient was improved (r = 0.795, P < 0.0001). The present results indicate that URINELISA had not only qualitative but quantitative accuracy. However, careful attention should be paid to cases with abnormalities in urinalysis when used quantitatively.