[Diagnosis of duplication of the sigmoid colon prior to surgery:a case study].

A 16-year-old woman identified with colonic distention using chest X-rays visited our hospital. Although abdominal computed tomography (CT), colonoscopy, and barium enema study indicated suspected duplication of the sigmoid colon, the exact portion of communication between the normal colon and the duplicated colon could not be determined. The patient was released, but followed up due to the lack of symptoms. After 7 months, she was urgently re-hospitalized due to the complaint of abdominal pain. Her abdominal CT revealed the wall thickness and distention of the duplication as well as voluminous stool containing barium. After the improvement of her symptoms and on the basis of the inflammatory findings, laparoscopic surgery was performed on the patient. Finally, the lesion was diagnosed as tubular- and continuous-type colonic duplication. Duplication of the colon is a relatively rare occurrence in adulthood. Herein, we report a case of duplication of the sigmoid colon diagnosed prior to surgery in an adult.

Efficacy of goshajinkigan for peripheral neurotoxicity of oxaliplatin in patients with advanced or recurrent colorectal cancer.

Peripheral neurotoxicity is the major limiting factor for oxaliplatin therapy. Goshajinkigan (GJG), a traditional Japanese herbal medicine, was recently shown to be effective in protecting against the neurotoxicity of taxanes in Japan. We retrospectively investigated the effect of GJG on peripheral neurotoxicity associated with oxaliplatin therapy. Ninety patients with metastatic colorectal cancer that received FOLFOX4 or modified FOLFOX6 therapy were assigned to receive one of the following adjuncts: oral GJG at 7.5 g day(-1) (Group A, n = 11), intravenous supplementation of calcium gluconate and magnesium sulfate (1 g each before and after FOLFOX) (Group B, n = 14), combined GJG and calcium gluconate and magnesium sulfate therapies (Group C, n = 21), or no concomitant therapy (Group D, n = 44). The incidence of peripheral neurotoxicity was investigated when the cumulative dose of oxaliplatin exceeded 500 mg m(-2). When the cumulative dose of oxaliplatin exceeded 500 mg m(-2), the incidence of neuropathy (all grades) in Groups A-D was 50.0%, 100%, 78.9%, and 91.7%, respectively. It was lowest in the group that received GJG alone. Concomitant administration of GJG reduced the neurotoxicity of oxaliplatin in patients that received chemotherapy for colorectal cancer.

[Pathogenesis and management of functional dyspepsia].

Functional dyspepsia (FD) is a condition with multifactorial pathogenesis, which includes dysmotility, increase of acid secretion, visceral hypersensitivity, psychological factors, H. pylori infection, genetic alteration, and/or inflammation. FD is common condition also in Japan, and the patients are usually managed as chronic gastritis for the sake of health insurance regulation in primary care setting. Presence of dyspeptic symptoms should be clearly discriminated from histologically defined chronic gastritis. Acid inhibition drugs and use of prokinetics are regarded as two major candidate drugs, yet only limited efficacy of these medicines has been reported by placebo-controlled trials. Although usefulness of other drug options, such as H. pylori eradication, psychotropic drugs, and/or herbal medicine has been reported, more evidence and validation studies for their efficacy are necessary.

Rikkunshito, a traditional Japanese medicine, may relieve abdominal symptoms in rats with experimental esophagitis by improving the barrier function of epithelial cells in esophageal mucosa.

BACKGROUND: A traditional Japanese medicine, rikkunshito, has been reported to relieve dyspepsia symptoms. We investigated the effect of rikkunshito on RE-induced abdominal dyspepsia, and performed experiments to elucidate the mechanism of that effect. METHODS: RE model rats were prepared using 8-week-old male Wistar rats, and rikkunshito was administered in drinking water. Voluntary movement was used as an index of RE-induced abdominal dyspepsia, which was monitored by an infrared sensor. On the tenth day after surgery, the total area of esophageal erosion was measured, and samples of nonerosive mucosa were collected. Using those samples, intercellular spaces of epithelial mucosa were examined by transmission electron microscopy, and the NP-40-soluble and -insoluble levels of the tight junction proteins claudin-1, -3 and -4 and their mRNAs were determined. RESULTS: Rikkunshito did not reduce the average total area of erosive lesions in the esophageal mucosa of RE model rats. On day 10, voluntary movement was significantly decreased in the RE model rats and rikkunshito significantly increased it. Nonerosive esophageal mucosa from RE rats showed dilation of intercellular spaces in epithelium, and significantly decreased claudin-3 mRNA and protein levels. Rikkunshito significantly suppressed intercellular space dilation and significantly increased the level of NP-40-insoluble claudin-3, but it did not affect the mRNA level, suggesting that it promoted tight junction formation by facilitating the translocation of proteins. CONCLUSION: Rikkunshito increased voluntary movement in RE model rats. This may have been because rikkunshito ameliorated the symptoms of RE by improving the barrier function of esophageal mucosa.

[Therapeutic trends of diseases of the upper gastrointestinal tract in patients with negative H. pylori status].

Many diseases of the upper gastrointestinal tract developed in patients with Helicobacter pylori (H. pylori) infection, thus the conditions unrelated to H. pylori are rare. Here, we described the therapeutic trends of diseases in H. pylori negative individuals. Proton pump inhibitor (PPI) is superior to H2 receptor antagonist in both gastroesohageal reflux disease (GERD) including reflux esophagitis and non-erosive reflux disease (NERD) whereas therapeutic gains of PPI treatment for NERD patients are lower than those reported in GERD because of heterogeneity of NERD pathophysiology. Endoscopic therapy for PPI refractory GERD patients remains to be established because there are few studies concerning the effectiveness or safety of the procedures. Main cause of H. pylori-negative ulcer diseases is the use of non-steroidal anti-inflammatory drugs (NSAIDs). PPI therapy is effective for both the prevention and treatment of NSAIDs-induced peptic ulcer. Considerations that should be entertained as causes of intractable peptic ulcers include Zollinger-Ellison syndrome or Crohn's disease. Gastric cancer and carcinoid tumor should be treated with endoscopic or surgical resection regardless of H. pylori infection. As for the treatment for gastric H. pylori-negative MALT lymphoma, radiation therapy (RT) should be selected first, and next chemotherapy will be given to the patients who failed to RT.