Relationship between primary eradication of Helicobacter pylori and drinking habits in women: collaborative research between a pharmacy and a clinic.

Helicobacter pylori is a cause of stomach cancer and peptic ulcer. For prevention, improving the eradication rate of H. pylori is crucial. However, the association between eradication and lifestyle of infected patients, including alcohol consumption, remains unclear. We explored associations between failed primary eradication therapy and drinking status by sex. This study involved 356 patients who visited a pharmacy with prescriptions for primary H. pylori eradication therapy. We assessed drinking habits using a questionnaire. Data on patients with failed primary eradication were provided by the nearby local clinic. We performed logistic regression analysis to examine the effect of drinking habit and frequency of drinking on failed primary eradication by sex. The odds ratio of primary eradication failure in female patients with a drinking habit was 3.75 (P = 0.001), but that in male patients was not significant. The odds ratio tended to increase in relation to drinking frequency in women. Frequent consumption of alcohol is not only likely to affect eradication, but also has a large impact on the bodies of women, who are more susceptible than men to the effects of alcohol. Thus, women should take greater care in alcohol consumption.

Diagnostic Performance and Patient Acceptance of Reduced-Laxative CT Colonography for the Detection of Polypoid and Non-Polypoid Neoplasms: A Multicenter Prospective Trial.

Purpose To evaluate the diagnostic accuracy and patient acceptance of reduced-laxative computed tomographic (CT) colonography without computer-aided detection (CAD) for the detection of colorectal polypoid and non-polypoid neoplasms in a population with a positive recent fecal immunochemical test (FIT). Materials and Methods Institutional review board approval and written informed consent were obtained. This multicenter prospective trial enrolled patients who had positive FIT results. Reduced-laxative CT colonography and colonoscopy were performed on the same day. Patients received 380 mL polyethylene glycol solution, 20 mL iodinated oral contrast agent, and two doses of 20 mg mosapride the day before CT colonography. The main outcome measures were the accuracy of CT colonography for the detection of neoplasms 6 mm or larger in per-patient and per-lesion analyses and a survey of patient perceptions regarding the preparation and examination. The Clopper-Pearson method was used for assessing the 95% confidence intervals of per-patient and per-lesion accuracy. Survey scores were analyzed by using the Wilcoxon and χ2 tests. Results Three hundred four patients underwent both CT colonography and colonoscopy. Per-patient sensitivity, specificity, positive predictive value, and negative predictive value of CT colonography for detecting neoplasms 10 mm or larger were 0.91 (40 of 44), 0.99 (255 of 258), 0.93 (40 of 43), and 0.98 (255 of 259), respectively; these values for neoplasms 6 mm or larger were 0.90 (71 of 79), 0.93 (207 of 223), 0.82 (71 of 87), and 0.96 (207 of 215), respectively. Per-lesion sensitivities for detection of polypoid and non-polypoid neoplasms 10 mm or larger were 0.95 (40 of 42) and 0.67 (six of nine), respectively; those for neoplasms 6 mm or larger were 0.90 (104 of 115) and 0.38 (eight of 21), respectively (P < .05 for both). Patient acceptance of preparation and examination with CT colonography was significantly higher than that with colonoscopy, and 62% (176 of 282) of patients would choose CT colonography as the first examination if they have a positive FIT result in the future. Conclusion Reduced-laxative CT colonography without CAD is accurate in the detection of polypoid neoplasms 6 mm or larger but is less accurate in the detection of non-polypoid neoplasms. Reduced-laxative CT colonography has high patient acceptance and is an efficient triage examination for patients with a positive FIT. © RSNA, 2016 Online supplemental material is available for this article.

Association of Hay Fever with the Failure of Helicobacter pylori Primary Eradication.

Objective Recently, the number of patients receiving Helicobacter pylori eradication treatment has dramatically increased in Japan, although the eradication rate has gradually decreased. Patient characteristics could affect the eradication rate. Our aim in this study was to investigate the association between failed first-line eradication therapy and hay fever. Methods We researched 356 patients who visited a pharmacy adjacent to the Internal Medicine clinic with a prescription for first-line H. pylori eradication treatment and investigated whether the patients had hay fever using a questionnaire. We separated these patients into 2 groups based on the success or failure of eradication according to the clinical data and performed a logistic regression analysis to investigate the influence of hay fever on first-line eradication failure. Results The eradication rate of patients with and without hay fever was 65.6% and 77.7%, respectively. The adjusted odds ratios according to which patients with hay fever would fail eradication therapy gradually lowered with increasing patient age [≤50 years, odds ratio (OR) 6.81, p=0.089; 51-60 years, OR 2.75, p=0.145; 61-70 years, OR 1.60, p=0.391; >70 years, OR 1.02, p=0.979]. A significant relationship was found for all patients (OR 1.88, p=0.047) and the age group ≤70 years (OR 2.31, p=0.024). Conclusion Patients with hay fever have difficulty with first-line eradication, especially younger patients. The existence of clarithromycin-resistant bacteria is suspected, and other factors may also be involved. When a hay fever sufferer receives first-line treatment, eradication might be difficult and other treatment may be required.

Gender differences in colorectal cancer survival in Japan.

BACKGROUND: A gender difference in survival has been documented in colorectal cancer (CRC) patients, although the underlying mechanism remains undefined. This study aimed to gain improved insight into this difference, with a special focus on improved cancer-specific survival. METHODS: The study population consisted of 82,402 patients with invasive CRC who had undergone surgery in Japan between 1985 and 2004. To estimate improved survival, multivariate adjustment using patient demographics and tumor characteristics was performed. RESULTS: Patient characteristics changed over time. The 5-year survival rates increased from 66.5 to 76.3 % during the study period. Higher survival rates persisted in women over time (multivariate-adjustment model-hazard ratio [HR] 0.87, 95 % confidence interval [CI] 0.85-0.90). Patients who received surgery during the period 2000-2004 had significantly longer survival than those during the period 1985-1989 (men: HR 0.70, 95 % CI 0.67-0.74; women: HR 0.72, 95 % CI 0.67-0.76). However, there was no gender difference regarding improved survival. CONCLUSIONS: A reduced risk of cancer-specific death for women relative to men persisted over time; however, enhancement of survival was equally observed in both genders. Identification of factors associated with gender differences and changes over time in CRC survival may serve as targets for further improvement.

Influence of extent of lymph node dissection on survival for patients with pT2 colon cancer.

PURPOSE: The optimal extent of lymph node dissection for early-stage colon cancer (CC) remains undefined. This study assessed the influence of the extent of lymph node dissection on overall survival (OS) in patients with pT2 CC. METHODS: We retrospectively examined data from the multi-institutional registry system of the Japanese Society for Cancer of the Colon and Rectum and used a propensity score matching method to balance potential confounders of lymph node dissection. We extracted 463 matched pairs from 1433 patients who underwent major resections for pT2 CC between 1995 and 2004. RESULTS: Lymph node metastasis was found in 301 (21.0%) of 1433 patients with pT2 CC. In this cohort, significant independent risk factors for lymph node metastasis were lymphatic invasion and venous invasion. Patients who underwent D3 or D2 lymph node dissection did not significantly differ in OS, either among the propensity score-matched cohort (estimated hazard ratio [HR] 0.85, 95% confidence interval [CI] 0.536-1.346, P = 0.484) or in the cohort as a whole (HR 0.720, 95% CI 0.492-1.052, P = 0.089). CONCLUSIONS: For patients with pT2 CC, D3 lymph node dissection did not add to OS. D2 lymph node dissection may be adequate for pT2 CC.

Endoscopic submucosal dissection and surgical treatment for gastrointestinal cancer.

Endoscopic submucosal dissection (ESD) is widely used in Japan as a minimally invasive treatment for early gastric cancer. The application of ESD has expanded to the esophagus and colorectum. The indication criteria for endoscopic resection (ER) are established for each organ in Japan. Additional treatment, including surgery with lymph node dissection, is recommended when pathological examinations of resected specimens do not meet the criteria. Repeat ER for locally recurrent gastrointestinal tumors may be difficult because of submucosal fibrosis, and surgical resection is required in these cases. However, ESD enables complete resection in 82%-100% of locally recurrent tumors. Transanal endoscopic microsurgery (TEM) is a well-developed surgical procedure for the local excision of rectal tumors. ESD may be superior to TEM alone for superficial rectal tumors. Perforation is a major complication of ESD, and it is traditionally treated using salvage laparotomy. However, immediate endoscopic closure followed by adequate intensive treatment may avoid the need for surgical treatment for perforations that occur during ESD. A second primary tumor in the remnant stomach after gastrectomy or a tumor in the reconstructed organ after esophageal resection has traditionally required surgical treatment because of the technical difficulty of ER. However, ESD enables complete resection in 74%-92% of these lesions. Trials of a combination of ESD and laparoscopic surgery for the resection of gastric submucosal tumors or the performance of sentinel lymph node biopsy after ESD have been reported, but the latter procedure requires a careful evaluation of its clinical feasibility.

Prognostic factors for recurrence following the initial drainage of an anorectal abscess.

PURPOSE: It is well known that recurrent abscesses and anal fistulas may develop following incision and drainage. In this study, the prognostic factors for recurrence of anorectal abscess were retrospectively examined following initial drainage. METHODS: Between November 2003 and April 2008, 205 patients with a diagnosis of anorectal abscess underwent initial incision and drainage at our hospital. We included only patients experiencing anorectal abscess for the first time, which represent the majority of anorectal abscess patients seen in regular clinical practice. RESULTS: Of the total of 205 subjects, 74 experienced recurrence and 131 were cured (without recurrence). An investigation on the prognostic factors for recurrence revealed that the time from disease onset to incision was the only significant prognostic factor (p = 0.001). Sex, age, body mass index, method of anesthesia, abscess location, anatomic classification, use of a drain, and comorbid diabetes mellitus had no influence on recurrence. The cumulative cure rates were 68.7% for 1 year, 64.2% for 2 years, and 63.5% for 3 years. CONCLUSION: For patients undergoing incision and drainage of anorectal abscesses, obesity did not affect recurrence. Prompt incision of anorectal abscesses was important to avoid recurrence.

The outcome of postoperative hemorrhaging following a hemorrhoidectomy.

PURPOSE: Postoperative hemorrhage (PH) is rare, but it is widely recognized as a postoperative complication of a hemorrhoidectomy. The assessment of this complication may provide information which can be used to improve the clinical outcome of a patient who has undergone a hemorrhoidectomy. METHODS: Between January 2006 and December 2007, a total of 1294 patients with symptomatic hemorrhoids underwent a hemorrhoidectomy at our hospital. The patient records were retrospectively analyzed. RESULTS: In this study, 23 patients had suffered from PH and had undergone a second operation (1.7%). The bleeding points were located as follows: 14 anterior,7 right laterally, 8 left laterally, and 2 posteriorly. Of these patients with early hemorrhage, 1 case was at the anterior, 1 was left lateral, and 2 were posterior. A significant correlation was observed between the period and the location of postoperative hemorrhage (P = 0.0023). From one to four piles were excised (1 in 264 patients, 2 in 240 patients, 3 in 702 patients, 4 in 88 patients). A significant correlation was also observed between the number of piles and the occurrence of PH (P = 0.032). CONCLUSIONS: At the posterior wall, a late period hemorrhage is less likely to be found than an early period hemorrhage. It was found that the more piles that were excised, the greater the occurrence of PH.