Comparison of an ecabet sodium and proton pump inhibitor (PPI) combination therapy with PPI alone in the treatment of endoscopic submucosal dissection (ESD)--induced ulcers in early gastric cancer: prospective randomized study.

BACKGROUND/AIMS: Ecabet sodium (ES) is a widely employed mucoprotective agent, for the treatment of gastric ulcers. The present paper prospectively evaluate the additive benefits of using ES in combination with the rabeprazole proton pump inhibitor (PPI) for the treatment of gastric ulcers after endoscopic submucosal dissection (ESD). METHODOLOGY: A total of 56 patients who had undergone ESD for early gastric cancers were randomly assigned to receive either PPI with ES (P/ES group, n=28) or PPI alone (PPI group, n=28) for 8 weeks. At 4 and 8 weeks after ESD, the healing rate and the diminution rate of the ulcers were compared between two groups by endoscopy. RESULTS: One patient in the PPI group developed a hemorrhage as a result of an ESD-induced ulcer. At 4 weeks, the healing rates were significantly higher in the P/ES group (40.7%) compared with the PPI group (11.5%), (p = 0.0013). This tendency was observed also at 8 weeks (p = 0.0446). In addition, at 4 weeks, the diminution rates of the ESD-induced ulcers were significantly higher in the P/ES group (95.8%) than in the PPI group (84.9%), (p=0.0033). CONCLUSIONS: ES in combination with PPI facilitates increased healing of ESD-induced ulcers, and can also improve the quality of ulcer healing.

Endoscopic findings can predict the efficacy of leukocytapheresis for steroid-naive patients with moderately active ulcerative colitis.

AIM: To investigate the therapeutic usefulness of leukocytapheresis (LCAP; Cellsoba) in steroid-naive patients with moderately active ulcerative colitis (UC). METHODS: Eighteen steroid-naive patients with moderately active UC received one LCAP session every week for five consecutive weeks. RESULTS: The remission rate 8 weeks after the last LCAP session was 61.1% (11/18). All three patients with deep ulcers showed worsening after LCAP. For the remaining 15 patients, who had erosions or geographic ulcers, the average clinical activity index (CAI) score dropped significantly from 9.4 to 3.8 eight weeks after the last LCAP session (t = 4.89, P = 0.001). The average C-reactive protein (CRP) levels before and after LCAP were 1.2 mg/dL and 1.0 mg/dL, respectively. Of the patients with erosions, geographic ulcers, and deep ulcers, 100% (9/9), 33.3% (2/6), and 0% (0/3) were in remission 8 weeks after the last LCAP session, respectively (chi(2) = 7.65, P < 0.005). Forty-eight weeks after the last LCAP session, the remission rates for patients with erosions and geographic ulcers were 44.4% (4/9) and 16.7% (1/6), respectively. Only one patient suffered a mild adverse event after LCAP (nausea). CONCLUSION: LCAP is a useful and safe therapy for steroid-naive UC patients with moderate disease activity. Moreover, the efficacy of the treatment can be predicted on the basis of endoscopic findings.

Serum proinflammatory cytokines and adhesion molecules in ulcerative colitis.

BACKGROUND/AIMS: The aim of this study was to define the correlation between serum markers, such as proinflammatory cytokines and adhesion molecules, and disease activity in ulcerative colitis (UC). METHODOLOGY: Nineteen patients with UC treated in our hospital from April 2003 to June 2004, were enrolled into this study. We measured serum interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule (VCAM-1) from a blood sample. We investigated the correlation between these cytokine molecules and clinical activity. RESULTS: Serum levels of IL-6 after treatment were significantly decreased proportionately as disease activity improved. Serum levels of IL-8 also significantly correlated with disease activity. On the other hand, serum levels of TNF-alpha were within the normal range in most of cases despite being in the active phase. There were also no significant differences between before and after treatment in serum levels of ICAM-1 or VCAM-1. CONCLUSIONS: Serum IL-6 and IL-8 significantly reflected disease activity in patients with UC.

Herpes simplex pancreatitis.

Lesions of the pancreas induced by viral infection have drawn relatively little attention because of their low incidence, and the histopathologic features of viral pancreatitis have not been fully elucidated. We report the autopsy findings of 2 patients, a 59-year-old woman with allergic granulomatous angiitis and a 73-year-old man with invasive pulmonary aspergillosis who had a disseminated visceral herpes simplex virus (HSV) infection. In both cases, the liver was the organ most severely affected by the viral infection. The pancreas showed multiple small foci of hemorrhagic necrosis, which were not accompanied by fat necrosis of the surrounding adipose tissue. Histopathologically, Cowdry type A intranuclear inclusions and a ground-glass appearance of the nuclei were found in many degenerated acinar cells around the necrotic foci. The gross appearance and histopathologic features of HSV pancreatitis were characteristic and, in particular, distinct from those of the more common acute hemorrhagic pancreatitis. Immunohistochemistry using an anti-HSV antibody revealed immunoreactivity in the intranuclear inclusions and ground-glass nuclei, and polymerase chain reaction analysis disclosed that the causative virus in these 2 cases was HSV-1. Herpes simplex virus pancreatitis constitutes a rare, but distinct pathologic entity among a group of acute pancreatitis diseases with diverse etiopathogenesis.