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1.
J Gastroenterol Hepatol ; 39(8): 1554-1562, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38628101

RESUMO

BACKGROUND AND AIM: We previously identified that ever-smoking and severe gastric atrophy in pepsinogen are risk factors for synchronous gastric cancers (SGCs). This study aimed to determine the association of alcohol drinking status or alcohol-related genetic polymorphism with SGCs and also stratify their risk. METHODS: This multi-center prospective cohort study included patients who underwent endoscopic submucosal dissection for the initial early gastric cancers at 22 institutions in Japan. We evaluated the association of alcohol drinking status or alcohol dehydrogenase 1B (ADH1B) and acetaldehyde dehydrogenase 2 (ALDH2) genotypes with SGCs. We then stratified the risk of SGCs by combining prespecified two factors and risk factors identified in this study. RESULTS: Among 802 patients, 130 had SGCs. Both the ADH1B Arg and ALDH2 Lys alleles demonstrated a significant association with SGCs on multivariate analysis (odds ratio, 1.77), although alcohol drinking status showed no association. The rates of SGCs in 0-3 risk factors in the combined evaluation of three risk factors (ever-smoking, severe gastric atrophy in pepsinogen, and both the ADH1B Arg and ALDH2 Lys alleles) were 7.6%, 15.0%, 22.0%, and 32.1%, respectively. The risk significantly increased from 0 to 3 risk factors on multivariate analysis (P for trend <0.001). CONCLUSIONS: Both the ADH1B Arg and ALDH2 Lys alleles were at high risk for SGCs. The risk stratification by these three factors may be a less invasive and promising tool for predicting their risk.


Assuntos
Álcool Desidrogenase , Consumo de Bebidas Alcoólicas , Aldeído-Desidrogenase Mitocondrial , Polimorfismo Genético , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologia , Álcool Desidrogenase/genética , Aldeído-Desidrogenase Mitocondrial/genética , Masculino , Feminino , Consumo de Bebidas Alcoólicas/efeitos adversos , Idoso , Pessoa de Meia-Idade , Fatores de Risco , Estudos Prospectivos , Medição de Risco , Neoplasias Primárias Múltiplas/genética , Neoplasias Primárias Múltiplas/patologia , Estudos de Coortes , Fumar/efeitos adversos , Japão/epidemiologia , Risco , Genótipo
2.
J Gastroenterol ; 58(5): 433-443, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36786863

RESUMO

BACKGROUND: No studies have evaluated the relationship between lifestyle and synchronous gastric cancers (SGCs) in patients with endoscopic submucosal dissection (ESD) for early gastric cancers (EGCs). Using data from the Tohoku gastrointestinal (GI) study, we aimed to identify factors associated with SGCs. METHODS: Tohoku GI study is a multicenter prospective cohort study investigating the relationship between lifestyle and metachronous gastric cancers. Patients who had a schedule to undergo ESD for primary EGCs were enrolled. We used logistic regression analysis to examine the relationship of 15 candidate factors, including lifestyle, with the prevalence of SGCs in this study. RESULTS: Of 850 patients between 2016 and 2019, 16.0% (136 patients) had SGCs. In multivariate analysis, smoking history (odds ratio [OR], 1.93; p = 0.048) and severe atrophic gastritis assessed by pepsinogen (OR, 1.92; p = 0.004) were risk factors for the prevalence of SGCs. Regarding smoking, current smoking (OR, 2.33; p = 0.021), but not former smoking (OR, 1.76; p = 0.098), was a significant risk factor for its prevalence. In the stratified analysis, severe atrophic gastritis assessed by pepsinogen was a risk factor in patients without Helicobacter pylori (H. pylori) eradication (OR, 2.10; p = 0.002), but not a risk factor in those with H. pylori eradication (OR, 0.75; p = 0.737). CONCLUSION: Smoking history was a risk factor for the prevalence of SGCs in patients with ESD for EGCs, and severe atrophic gastritis assessed by pepsinogen was also a risk factor when H. pylori was not eradicated.


Assuntos
Ressecção Endoscópica de Mucosa , Gastrite Atrófica , Infecções por Helicobacter , Helicobacter pylori , Neoplasias Gástricas , Humanos , Gastrite Atrófica/epidemiologia , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/cirurgia , Pepsinogênio A , Ressecção Endoscópica de Mucosa/efeitos adversos , Prevalência , Estudos Prospectivos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/epidemiologia
3.
Nihon Shokakibyo Gakkai Zasshi ; 112(5): 896-904, 2015 May.
Artigo em Japonês | MEDLINE | ID: mdl-25947026

RESUMO

Two patients were referred to our hospital with cystic lesion (diameter 5 cm) of the pancreas and elevated serum CEA and CA19-9. We diagnosed them with malignant cystic neoplasms of the pancreas and performed distal pancreatectomy. Histologically, in both cases the cysts were lined with flat, transitional, squamoid cells without keratinization. Immunohistochemical staining confirmed two rare cases of squamoid cyst of the pancreatic ducts.


Assuntos
Cisto Pancreático/patologia , Ductos Pancreáticos/patologia , Idoso , Antígeno CA-19-9/sangue , Antígeno Carcinoembrionário/sangue , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Pancreatectomia , Cisto Pancreático/cirurgia , Ductos Pancreáticos/cirurgia , Neoplasias Pancreáticas/sangue , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
4.
Gastrointest Endosc ; 69(3 Pt 2): 637-44, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19251004

RESUMO

BACKGROUND: Clinical demand for total colonoscopy (TCS) is increasing. Improvement of the cecal intubation rate and shortening of the examination time would expand the capacity for TCS. OBJECTIVE: To assess the efficacy of a transparent hood attached to the tip of a colonoscope for cecal intubation in TCS. DESIGN: Prospective, randomized, controlled study. SETTING: Single tertiary-referral center. INTERVENTIONS: TCS. MAIN OUTCOME MEASUREMENTS: Cecal intubation time and rate, complications, patient discomfort, and detection rate of colonic polyps. METHODS: Patients who were to undergo screening and/or surveillance TCS for colorectal cancer were invited to participate in the study. Cecal intubation time and rate, complications, patient discomfort, and detection rate of colonic polyps were evaluated. RESULTS: A total of 592 patients enrolled in this study were randomly allocated to the hood group and no-hood group. The mean (SD) cecal intubation time in the hood group and the no-hood group was 10.2 +/- 12.5 minutes and 13.4 +/- 15.8 minutes, respectively (P = .0241). The effect of its use was more prominent in the expert endoscopists group compared with those with moderate experience. The cecal intubation rate and the detection rate of small polyps in the 2 groups were similar. The grade of patient discomfort was significantly lower in the hood group. No complications were encountered with the use of the hood. CONCLUSIONS: Use of a transparent hood on the tip of a colonoscope shortened the time required for cecal intubation and decreased patient discomfort; such use was more effective among experts in shortening the examination time.


Assuntos
Colonoscópios , Colonoscopia/métodos , Ceco , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
5.
Nihon Shokakibyo Gakkai Zasshi ; 105(7): 1078-86, 2008 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-18603854

RESUMO

A 26-year-old woman was admitted to our hospital with jaundice. Under a diagnosis of biliary and duodenal stenosis due to so called "groove pancreatitis", prednisolone (30 mg/day, 2 weeks) was administered. But these stenosis did not improve after the treatment, and pancreaticoduodenectomy was performed. Histologically, poorly differentiated adenocarcinoma was found in the "groove" between the duodenum and the pancreatic head. We should be kept of "pancreatic groove carcinoma" in mind when making a diagnosis of "groove pancreatitis".


Assuntos
Adenocarcinoma/patologia , Neoplasias Pancreáticas/patologia , Adulto , Feminino , Humanos
6.
J Gastroenterol ; 43(4): 305-11, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18458847

RESUMO

BACKGROUND: We investigated the presence of occult pancreaticobiliary reflux in patients with a morphologically normal pancreaticobiliary ductal arrangement by measuring biliary amylase levels and compared histopathological findings of the gallbladder between groups with high and low biliary amylase levels. METHODS: In 178 patients with a normal pancreaticobiliary ductal arrangement who had undergone endoscopic retrograde cholangiopancreatography (ERCP), we sampled bile from the bile duct and measured amylase levels. Then we compared clinical features and histological findings of the gallbladder between high (HALG) and low amylase level groups (LALG). RESULTS: A high biliary amylase level was observed in 25.8% (46/178) of the patients. The prevalence of a high biliary amylase level was high in patients with gallbladder carcinoma (40%) and in those with choledocholithiasis (28.4%). The level of amylase in bile was high in patients with gallbladder carcinoma, adenomyomatosis of the gallbladder, and chronic cholecystitis. A strong correlation between the levels of amylase and lipase in bile and the dominance of amylase of pancreatic origin in bile were confirmed by isozyme analysis. Thickening of the gallbladder mucosa was a significant manifestation in HALG. Histological examination of the gallbladder mucosa showed that incidences of metaplastic change and atypical epithelium and Ki67-LI in were higher in HALG than in LALG. CONCLUSIONS: Occult pancreaticobiliary reflux is observed in a considerable number of ERCP candidates. Those who show an extremely high biliary amylase level, at least, may be at high risk for biliary malignancies.


Assuntos
Amilases/metabolismo , Ductos Biliares/enzimologia , Bile/enzimologia , Carcinoma/enzimologia , Coledocolitíase/enzimologia , Neoplasias da Vesícula Biliar/enzimologia , Pâncreas/enzimologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Carcinoma/diagnóstico , Coledocolitíase/diagnóstico , Diagnóstico Diferencial , Feminino , Seguimentos , Neoplasias da Vesícula Biliar/diagnóstico , Humanos , Lipase/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
7.
J Gastroenterol ; 42(12): 957-61, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18085352

RESUMO

BACKGROUND: The aim of this study was to evaluate histopathologically the frequency, direction, and length of intraductal spread (IS) along the main pancreatic duct from the main tumor of small pancreatic cancer. METHODS: Resected specimens from 20 cases of pTS1 (histologically 2 cm or less in diameter) pancreatic cancer (September 1983 to December 2005) were examined histopathologically. As controls, 40 resected specimens from cases of pTS2 (more than 2 cm and less than 4 cm in diameter) or larger sized pancreatic cancer (pTS2

Assuntos
Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/secundário , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/secundário , Idoso , Idoso de 80 Anos ou mais , Carcinoma Intraductal não Infiltrante/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Ductos Pancreáticos/patologia , Suco Pancreático/citologia , Neoplasias Pancreáticas/fisiopatologia
8.
J Gastroenterol ; 42(3): 211-8, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17380279

RESUMO

BACKGROUND: We histologically evaluated the epithelia of the gallbladder (GB) and bile duct (BD) in patients with anomalous arrangement of the pancreaticobiliary ductal system (AAPB), with regard to the shape of the common BD (CBD). METHODS: The GB and BD were studied histologically using surgical materials from 44 patients with AAPB: 27 with a dilated CBD (D-type) and 17 with a nondilated CBD (N-type). RESULTS: GB cancer and BD cancer were found in 11.1% and 3.7% of D-type and 17.6% and 0% of N-type respectively. Hyperplastic epithelium and atypical epithelium of the GB were frequently seen in both D-type (46%, 46%) and N-type (82%, 70%), while such epithelia of the BD were only seen in D-type (10%, 35%). The Ki67 labeling index of the nonneoplastic epithelium of the GB was high in both D-type (13.0%) and N-type (9.7%), though that of the BD was high in D-type (12.5%) but low in N-type (1.8%). The prevalences of pyloric gland metaplasia, intestinal metaplasia, and p53 protein overexpression of the nonneoplastic epithelium did not show any significant differences between D-type and N-type. CONCLUSIONS: It is suggested that the BD epithelium of N-type probably has a lower potential for developing malignancy than that of D-type, while the GB epithelia of both D-type and N-type have a high potential for developing malignancy. This might support the selection of simple cholecystectomy as the treatment of choice in AAPB patients of N-type, although further investigation of the BD epithelium is required in a larger number of such patients.


Assuntos
Ductos Biliares/anormalidades , Ductos Biliares/patologia , Ducto Colédoco/patologia , Vesícula Biliar/patologia , Ductos Pancreáticos/anormalidades , Adolescente , Adulto , Idoso , Neoplasias dos Ductos Biliares/epidemiologia , Dilatação Patológica , Epitélio/patologia , Feminino , Neoplasias da Vesícula Biliar/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade
10.
Nihon Rinsho ; 62(3): 442-7, 2004 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-15038084

RESUMO

Helicobacter pylori(H. pylori) is an important pathogenic factor for gastroduodenal ulcers and gastric cancer. The level of gastric acid output may influence the outcome of those diseases. With low acid output, H. pylori can spread to the corpus of the stomach, resulting in progression to atrophic gastritis. It may cause an increased risk of gastric cancer and ulcer. In contrast, with high output, H. pylori is confined in the gastric antrum, which develops antrum-predominant gastritis. This may contribute to an increased risk of duodenal ulcer. It is well known that inflammatory cytokines including interleukin (IL)-1 beta, IL-8 and tumor necrosis factor alpha modulate gastric acid secretion. Therefore, the host immune response by the cytokines may cause these disparate pathways in gastric acid secretion.


Assuntos
Ácido Gástrico/metabolismo , Gastrite Atrófica/etiologia , Infecções por Helicobacter/fisiopatologia , Helicobacter pylori , Interleucina-1/fisiologia , Interleucina-8/fisiologia , Úlcera Péptica/etiologia , Fator de Necrose Tumoral alfa/fisiologia , Humanos
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