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1.
Gastrointest Endosc ; 2020 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-32376336

RESUMEN

BACKGROUND AND AIMS: Postoperative stricture after expansive esophageal endoscopic submucosal dissection (ESD) is a severe adverse event. Previous single-arm reports have suggested that polyglycolic acid (PGA) shielding may prevent stricture. This study was performed to assess the efficacy of this method through a comparative analysis. METHODS: This is a retrospective analysis of 500 consecutive cases of esophageal ESD performed between 2002 and 2018 at the University of Tokyo Hospital. After 2013, patients with a diagnosis of superficial esophageal carcinoma covering over 1/2 the esophageal circumference underwent preventive treatment with either "PGA shielding" or "steroid injection + PGA shielding" after ESD. The efficacy of these methods for preventing post-ESD stricture was assessed through multivariable logistic regression analysis. RESULTS: The risk of postoperative stricture was especially high in the cervical esophagus (OR, 4.60; 95% CI, 0.65-61.09) and after total circumferential resection (OR, 3.58×103; lower bound of 95% CI > 185). "Steroid injection + PGA shielding" was the only method significantly effective in preventing stricture (OR, 0.30; 95% CI, 0.10-0.78; p = 0.009). In the relatively low-risk subgroup (excluding cervical esophageal cancer and complete circumferential resection), the postoperative stricture rates for "steroid injection + PGA shielding" versus "PGA shielding" versus "control" were 18.9% versus 41.4% versus 51.7%, respectively (p = 0.015). However, the efficacy of this was limited in extremely high-risk cases. CONCLUSION: The combination of steroid injection and PGA shielding is effective for preventing post-ESD stricture. There is a need for even more effective methods for cervical esophageal cancer and complete circumferential resection.

3.
Int Heart J ; 61(1): 15-20, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32009122

RESUMEN

Body weight gain in middle age is thought to be mainly attributable to body fat gain. However, the association between the change in body weight and change in fat weight is not fully understood. In this study, we aimed to clarify the association between the changes in body weight and fat weight in a middle-aged general population using a community-based cohort. We studied 3,193 subjects who underwent health check-ups. Fat weight was measured using a TANITA DC-270A body composition analyzer (Tanita Corporation, Tokyo). Good correlation was observed between the changes in body weight and fat weight (Pearson r = 0.88, P < 0.001). Among the study subjects, 408 (13%) were categorized in the weight loss group (weight loss ≥ 5%), 2,442 (76%) in the weight stable group, and 343 (11%) in the weight gain group (weight gain ≥ 5%). The percentage of change in fat weight in relation to the change in body weight was 65% on average in subjects with body weight loss, and 70% on average in those with body weight gain. Good correlation between changes in body weight and fat weight was observed regardless of age, gender, and baseline body mass index. A change in body weight was closely correlated with a change in fat weight among the middle-aged general population. Body weight change in the middle-age population appears to be mainly attributable to the change in fat weight.


Asunto(s)
Tejido Adiposo/crecimiento & desarrollo , Peso Corporal/fisiología , Aumento de Peso/fisiología , Tejido Adiposo/fisiología , Anciano , Composición Corporal , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología
4.
Int Heart J ; 61(1): 103-108, 2020 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-31956154

RESUMEN

Waist circumference (WC) is measured for the assessment of abdominal obesity, whereas carotid intima-media thickness (IMT) is a marker of preclinical atherosclerosis. The relationship between WC and carotid IMT in the general population is not fully understood. In this study, we examined 1,182 subjects (658 men and 524 women, 62.3 ± 11.7 years on average) who underwent voluntary health check-ups and sought to determine the optimal cut-off value of WC for predicting carotid IMT thickness. Receiver operating characteristic curve analysis of WC was utilized to predict high carotid IMT (defined as carotid IMT ≥ 1.1 mm). We determined that the appropriate WC cut-off value was a WC ≥ 79 cm for men and women. There was a statistically significant difference in the prevalence of high carotid IMT between WC ≥ 79 cm and WC < 79 cm in both men and women. However, multivariable logistic regression analysis demonstrated that the WC category was independently associated with high carotid IMT in men, but not in women. Our study indicates that the optimal cut-off value of WC to identify preclinical atherosclerosis may be lower than the current Japanese diagnostic criteria for metabolic syndrome (MetS) in both men and women. Compared to women, the association between WC and preclinical atherosclerosis may be more pronounced in men.


Asunto(s)
Aterosclerosis/diagnóstico , Obesidad Abdominal/diagnóstico , Anciano , Aterosclerosis/epidemiología , Grosor Intima-Media Carotídeo , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Obesidad Abdominal/epidemiología , Prevalencia , Curva ROC , Factores Sexuales , Circunferencia de la Cintura
5.
Heart Vessels ; 35(1): 22-29, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31222551

RESUMEN

Cigarette smoking is closely associated with the development of cardiovascular diseases. However, the relationship between cigarette smoking and subclinical atherosclerosis has not been fully studied. We sought to clarify the association between cigarette smoking and carotid intima-media thickness (cIMT) in a general Japanese population. Among 1,209 participants who received a medical check-up with cardiovascular examination at our institution, 450 participants (37.2%) were smokers (including both past and current smokers). We evaluated cIMT as a marker of subclinical atherosclerosis. The value of cIMT and rate of carotid plaque defined as IMT ≥ 1.1 mm did not differ between smokers and never smokers. However, the rate of carotid high-risk atheroma, defined as carotid artery atheroma including hypoechoic dominant and ulceration, was significantly higher among smokers than never smokers (30.4%, vs 23.6%, p = 0.009). Even after adjustment for covariates, cigarette smoking was independently associated with high-risk atheroma formation (odds ratio 1.384, 95% CI 1.019-1.880; p = 0.038). The value of cIMT and the rate of high-risk atheroma were significantly higher in smokers than never smokers in the subgroup of participants aged ≥ 60 years, whereas the rate of high-risk atheroma only was higher in smokers than never smokers in the subgroup of participants aged < 60 years. In conclusion, the development of high-risk carotid artery atheroma may precede the thickening of cIMT in cigarette smokers, which suggests the novel insight for the pathological mechanism underlying cardiovascular events and cigarette smoking.

6.
J Atheroscler Thromb ; 27(2): 155-163, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-31231080

RESUMEN

AIM: Obesity and metabolic syndrome (MetS) frequently coexist and are both important risk factors for cardiovascular disease. However, the pathophysiological role of obesity without MetS, also referred to as metabolically healthy obesity (MHO), remains unclear. In this study, we aim to clarify the effect of MHO on the development of carotid plaque using a community-based cohort. METHODS: We examined 1,241 subjects who underwent health checkups at our institute. Obesity was defined as body mass index of ≥ 25.0 kg/m2. Subjects were divided into three groups: non-obese, MHO, and metabolically unhealthy obesity (MUO). RESULTS: The prevalence of carotid plaque, defined as intima-media thickness (IMT) ≥ 1.1 mm, was higher in subjects with MUO and MHO than in non-obese subjects. Multivariable analysis demonstrated that MHO (odds ratio 1.6, p=0.012) and MUO (odds ratio 1.9, p=0.003) as well as age of ≥ 65 years, male sex, hypertension, and diabetes mellitus were independently associated with carotid plaque formation. A similar trend was observed in each subgroup according to age and sex. CONCLUSIONS: MHO increased the prevalence of carotid plaque when compared with non-obese subjects, suggesting the potential significance of MHO in the development of subsequent cardiovascular diseases.

7.
J Cardiol ; 75(5): 578-582, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-31874723

RESUMEN

BACKGROUND: The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for hypertension have lowered the threshold of normal blood pressure (BP). However, how this updated guideline should be applied to the general population is still under debate, and may depend on gender because of a substantial gender difference in the risk of cardiovascular disease. We aimed to clarify the gender difference in the association between BP category and cardio-ankle vascular index (CAVI), as a marker of subclinical atherosclerosis, using a community-based cohort. METHODS: We examined 1,241 subjects (699 males and 542 females) who underwent health check-ups at our institute. We defined normal pressure as systolic (s)BP <130 mmHg and diastolic (d)BP <80 mmHg, stage 1 hypertension as 130 mmHg ≤ sBP < 140 mmHg or 80 mmHg ≤ dBP <90 mmHg and stage 2 hypertension as sBP ≥140 mmHg or dBP ≥90 mmHg, including subjects on antihypertensive medications. High CAVI was defined as CAVI ≥9.0. RESULTS: Age and the prevalence of most of atherosclerotic risk factors increased with increasing BP category in both male and female subjects. A linear relationship between the prevalence of high CAVI and high BP category was observed in males, but not in females. Multivariable logistic regression analysis revealed that BP category was independently associated with high CAVI in males but not in females. CONCLUSION: There was a difference seen between males and females in the association between BP category, according to the updated ACC/AHA guideline, and CAVI, suggesting that the optimal management strategy for hypertension may depend on not only age, obesity, and diabetes mellitus, but also gender.

10.
Int Heart J ; 60(6): 1381-1386, 2019 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-31735787

RESUMEN

The association between changes in body weight and blood pressure (BP) in overweight people in the general population still remains unclear. We sought to clarify the effect of body weight change on BP using a community-based cohort. We studied 1,170 overweight subjects with a body mass index (BMI) ≥ 22 kg/m2 who underwent health check-ups. Among the study subjects, 175 (15%) were categorized in the weight loss group (weight loss ≥ 5%), 869 (74%) in the weight stable group, and 126 (11%) in the weight gain group (weight gain ≥ 5%). There were no significant differences in baseline BP between the 3 groups. In the weight loss group, systolic and diastolic BP, and the rates of stage 2 (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) and stage 1 hypertension (130 mmHg≤ systolic BP < 140 mmHg or 80 mmHg≤ diastolic BP < 90 mmHg) decreased. In contrast, in the weight gain group, systolic and diastolic BP and the rate of stage 2 hypertension increased. Subgroup analysis showed that the correlation between change in body weight and BP was seen in each subgroup according to age, sex, and BMI. The results of the present study suggest the significance of body weight control for BP control in subjects with BMI ≥ 22 kg/m2.


Asunto(s)
Presión Sanguínea , Índice de Masa Corporal , Hipertensión/epidemiología , Sobrepeso/fisiopatología , Aumento de Peso , Pérdida de Peso , Adulto , Anciano , Estudios de Cohortes , Femenino , Frecuencia Cardíaca , Humanos , Japón , Masculino , Persona de Mediana Edad , Sobrepeso/complicaciones
11.
Biochem Biophys Rep ; 18: 100632, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30993217

RESUMEN

MUC5AC is a well-known gastric differentiation marker, which has been frequently used for the classification of stomach cancer. However, the molecular mechanism of regulation of MUC5AC expression remains to be elucidated. In previous studies, we have shown that Gli regulated MUC5AC transcription through the Gli-binding motif in the 5' region of MUC5AC. Gli played important roles, but independently was not sufficient for MUC5AC expression. In this study, we analyzed a 4010 bp fragment of the 5'-flanking promoter region of the human MUC5AC gene by luciferase assay, and found a novel distal enhancer region located between -1434 bp to -3000 bp upstream from the first ATG initiation codon. This region is composed of repetitive DNA sequences 5'-TCACTCAC-3'. The strength of enhancer activities depended on the length of the repetitive region. The tandem repeats are conserved among primates, but not in other mammals. The tandem repeat regions enhanced promoter activities not only of MUC5AC but also of other genes. The enhancer effect of the tandem repeat regions was maintained even when inverted. ChIP analysis revealed that H3K9me3 binds to the tandem repeat regions. Together, our results suggest that the tandem repeat region in the MUC5AC promoter has the potential to act as a strong enhancer, and H3K9me3 may contribute to histone modifications of this region.

12.
United European Gastroenterol J ; 7(3): 343-348, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-31019702

RESUMEN

Background: We previously showed that the endoscopic Kyoto classification for gastritis could predict Helicobacter pylori infection in individuals with a high negative titer of serum anti-H pylori antibodies. This study evaluated H pylori infection and the Kyoto classification score in patients with a low negative titer (<3 U/ml), high negative titer (3-9.9 U/ml), low positive titer (10-49.9 U/ml), and high positive titer (≥50 U/ml). Methods: Serum antibody levels, Kyoto classification score and histology were investigated in 870 individuals with no history of H pylori-eradication therapy. Urea breath tests (UBTs) were additionally conducted for patients with a low negative titer and a Kyoto score ≥1 or an antibody titer ≥10 U/ml and a Kyoto score of 0 or 1. UBTs and/or histological studies were conducted for participants with a high negative titer. Results: False diagnoses based on anti-H pylori antibody titers were observed in 0.3% of the low-negative-titer group, 11.7% of the high-negative-titer group, 18.9% of the low-positive-titer group and 2.2% of the high-positive-titer group. Surprisingly, false diagnoses based on antibody titers were noted in 63.2% of patients with a low positive titer and a Kyoto score of 0 and in 62.5% of patients with a high negative titer and a Kyoto score ≥2, respectively. Conclusions: Endoscopic findings could predict false diagnoses determined using serum antibody titers.

13.
Endoscopy ; 51(7): 619-627, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-30861532

RESUMEN

BACKGROUND: Bleeding after endoscopic submucosal dissection (ESD) is a severe adverse event. Recent reports have described the efficacy of the endoscopic shielding method with polyglycolic acid (PGA) sheets and fibrin glue for the prevention of adverse events after ESD. The aim of the present study was to investigate whether the PGA shielding method provides additional benefit in preventing post-ESD bleeding compared with standard care. METHODS: This was a prospective, multicenter, randomized controlled trial. Patients at high risk of post-ESD bleeding were enrolled in the study. Before ESD, patients were randomized to either the PGA group or the control group. After completing ESD in the PGA group, PGA sheets were placed onto the ulcer floor and adhered with fibrin glue. The primary end point was the post-ESD bleeding rate. RESULTS: 140 eligible patients were enrolled from September 2014 to September 2016, and 137 were included in the intention-to-treat analysis (67 in the PGA group and 70 in the control group). Post-ESD bleeding occurred in three patients (4.5 %) in the PGA group and in four patients (5.7 %) in the control group; there was no significant difference between the two groups (P > 0.99). Post-ESD bleeding tended to occur later in the control group than in the PGA group (median 12.5 days [range 8 - 14] vs. 2 days [range 0 - 7], respectively). CONCLUSION: The PGA shielding method did not demonstrate a significant effect on the prevention of post-ESD bleeding.

14.
J Gastroenterol ; 54(4): 321-329, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30284046

RESUMEN

BACKGROUND: Deep learning has become a new trend of image recognition tasks in the field of medicine. We developed an automated gastritis detection system using double-contrast upper gastrointestinal barium X-ray radiography. METHODS: A total of 6520 gastric X-ray images obtained from 815 subjects were analyzed. We designed a deep convolutional neural network (DCNN)-based gastritis detection scheme and evaluated the effectiveness of our method. The detection performance of our method was compared with that of ABC (D) stratification. RESULTS: Sensitivity, specificity, and harmonic mean of sensitivity and specificity of our method were 0.962, 0.983, and 0.972, respectively, and those of ABC (D) stratification were 0.925, 0.998, and 0.960, respectively. Although there were 18 false negative cases in ABC (D) stratification, 14 of those 18 cases were correctly classified into the positive group by our method. CONCLUSIONS: Deep learning techniques may be effective for evaluation of gastritis/non-gastritis. Collaborative use of DCNN-based gastritis detection systems and ABC (D) stratification will provide more reliable gastric cancer risk information.

15.
J Gastroenterol ; 54(2): 131-140, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29951927

RESUMEN

BACKGROUND: The mechanism behind the pathogenesis and carcinogenesis of these neoplasms is not fully understood. The objective of this study was to identify genetic markers and pathways specific to precancerous duodenal adenomas and early stage adenocarcinomas through gene expression analysis. METHODS: Gene expression profiling was performed in 4 pairs of duodenal adenoma/adenocarcinomas and corresponding matched normal tissue. Genes with consistent expression differences were identified and confirmed in 7 independent pairs. Gene set enrichment analysis (GSEA) was performed to characterize gene expression profiles of duodenal adenoma/adenocarcinomas, together with immunohistochemical staining of candidate oncogenic genes. RESULTS: 626 probes consistently demonstrated over a twofold expression difference between tumor-normal pairs. Reverse transcriptase polymerase chain reaction of genes with the most prominent difference in expression between tumors and normal mucosa (KLK7, KLK6, CEMIP, MMP7, KRT17, LGR5, G6PC, S100G, APOA1) validated the results of gene expression analysis. GSEA demonstrated a strong association between duodenal adenoma/adenocarcinomas with colorectal adenomas (p < 10-5) and gene expression patterns seen after APC gene knockout (p < 10-5), suggesting that the Wnt/ß-catenin pathway plays a crucial role in the carcinogenesis of these neoplasms. Immunohistochemical staining of an independent group of duodenal adenomas confirmed over-accumulation of ß-catenin in 80.0% (16/20). CONCLUSIONS: Precancerous duodenal adenomas and early stage adenocarcinomas demonstrate gene expression characteristics with a strong resemblance to colorectal adenomas. The results of this study strongly suggest that upregulation of the Wnt/ß-catenin pathway is the major factor involved in the initial stages of the carcinogenesis of duodenal adenocarcinomas.

16.
Cancer Sci ; 109(12): 3853-3864, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30289576

RESUMEN

Intestinal metaplasia induced by ectopic expression of caudal-type homeobox (CDX)2 and/or CDX1 (CDX) is frequently observed around gastric cancer (GC). Abnormal expression of CDX is also observed in GC and suggests that inappropriate gastrointestinal differentiation plays essential roles in gastric tumorigenesis, but their roles on tumorigenesis remain unelucidated. Publicly available databases show that GC patients with higher CDX expression have significantly better clinical outcomes. We introduced CDX2 and CDX1 genes separately into GC-originated MKN7 and TMK1 cells deficient in CDX. Marked suppression of cell growth and dramatic morphological change into spindle-shaped flat form were observed along with induction of intestinal marker genes. G0-G1 growth arrest was accompanied by changed expression of cell cycle-related genes but not with apoptosis or senescence. Microarray analyses additionally showed decreased expression of gastric marker genes and increased expression of stemness-associated genes. Hierarchical clustering of 111 GC tissues and 21 non-cancerous gastric tissues by selected 18 signature genes based on our transcriptome analyses clearly categorized the 132 tissues into non-cancer, "CDX signature"-positive GC, and "CDX signature"-negative GC. Gene set enrichment analysis indicated that "CDX signature"-positive GC has lower malignant features. Immunohistochemistry of 89 GC specimens showed that 50.6% were CDX2-deficient, 66.3% were CDX1-deficient, and 44.9% were concomitant CDX2/CDX1-deficient, suggesting that potentially targetable GC cases by induced intestinal differentiation are quite common. In conclusion, exogenous expression of CDX2/CDX1 can lead to efficient growth inhibition of CDX-deficient GC cells. It is based on rapidly induced intestinal differentiation, which may be a future therapeutic strategy.


Asunto(s)
Factor de Transcripción CDX2/genética , Factor de Transcripción CDX2/metabolismo , Proteínas de Homeodominio/genética , Proteínas de Homeodominio/metabolismo , Neoplasias Gástricas/genética , Diferenciación Celular , Línea Celular Tumoral , Proliferación Celular , Perfilación de la Expresión Génica , Regulación Neoplásica de la Expresión Génica , Redes Reguladoras de Genes , Humanos , Análisis de Secuencia por Matrices de Oligonucleótidos , Neoplasias Gástricas/terapia , Análisis de Supervivencia , Transducción Genética
17.
Pathol Int ; 68(10): 557-562, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30221498

RESUMEN

Gastric cancer (GC) is rich in many different histological types, but how the histological pattern is defined remains to be proved. The relation between GC histological types and the expression of nectin1, which is one of the cell adhesion molecules that composes adherens junction, has not been reported. According to a publicly available database of 406 GC patients, the median overall survival of Nectin1 high expression patients was 55.4 months and that of low expression patients was 25.6 months (P = 0.0246). Using surgically or endoscopically resected GC samples, nectin1 expression was analyzed by immunohistochemistry. Nectin1 expressed at adherens junction in all the normal epithelial cells. However, nectin1 expressed not at adherens junction but at apical membrane in epithelial cells in intestinal metaplasia. The expression pattern of nectin1 in intestinal type GC resembled to intestinal metaplasia. In order to analyze the difference in nectin1 expression between GC histological types, a total of 116 intestinal type GC and 33 diffuse type GC. The expression of necitin1 in diffuse type GC (3.0%) was remarkably decreased compared to that in intestinal type GC (65.5%) (P < 0.0001). In conclusion, this is the first report showing an association between nectin1 expression and histological subtypes of GC.


Asunto(s)
Adenocarcinoma/patología , Biomarcadores de Tumor/análisis , Nectinas/biosíntesis , Neoplasias Gástricas/patología , Adenocarcinoma/mortalidad , Adulto , Anciano , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Nectinas/análisis , Pronóstico , Neoplasias Gástricas/mortalidad
18.
World J Gastroenterol ; 24(35): 4061-4068, 2018 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-30254410

RESUMEN

AIM: To clarify the role of serum anti-Helicobacter pylori (H. pylori) antibody titers in gastric cancer. METHODS: In this cross-sectional study, the effect of patients' baseline characteristics and endoscopic findings on their serum antibody titers were assessed. We evaluated consecutive patients who underwent esophagogastroduodenoscopy and their first evaluation for H. pylori infection using a serum antibody test. We excluded patients with a history of eradication therapy. The participants were divided into four groups according to their E-plate serum antibody titer. Patients with serum antibody titers < 3, 3-9.9, 10-49.9, and ≥ 50 U/mL were classified into groups A, B, C, and D, respectively. RESULTS: In total, 874 participants were analyzed with 70%, 16%, 8.7%, and 5.1% of them in the groups A, B, C, and D, respectively. Patients in group C were older than patients in groups A and B. Gastric open-type atrophy, intestinal metaplasia, enlarged folds, diffuse redness, and duodenal ulcers were associated with a high titer. Regular arrangements of collecting venules, fundic gland polyps, superficial gastritis, and gastroesophageal reflux disease were related to a low titer. Multivariate analysis revealed that nodularity (P = 0.0094), atrophy (P = 0.0076), and age 40-59 years (vs age ≥ 60 years, P = 0.0090) were correlated with a high serum antibody titer in H. pylori-infected patients. Intestinal metaplasia and atrophy were related to age ≥ 60 years in group C and D. CONCLUSION: Serum antibody titer changes with age, reflects gastric mucosal inflammation, and is useful in predicting the risk of gastric cancer.


Asunto(s)
Anticuerpos/sangre , Mucosa Gástrica/patología , Infecciones por Helicobacter/sangre , Helicobacter pylori/inmunología , Mucosa Intestinal/patología , Adulto , Factores de Edad , Anciano , Atrofia/sangre , Atrofia/diagnóstico por imagen , Atrofia/inmunología , Atrofia/microbiología , Estudios Transversales , Endoscopía del Sistema Digestivo , Femenino , Mucosa Gástrica/diagnóstico por imagen , Mucosa Gástrica/microbiología , Infecciones por Helicobacter/inmunología , Infecciones por Helicobacter/microbiología , Infecciones por Helicobacter/patología , Helicobacter pylori/aislamiento & purificación , Humanos , Mucosa Intestinal/diagnóstico por imagen , Mucosa Intestinal/microbiología , Masculino , Metaplasia/sangre , Metaplasia/diagnóstico por imagen , Metaplasia/inmunología , Metaplasia/microbiología , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Pruebas Serológicas
19.
Digestion ; 98(4): 201-208, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30045036

RESUMEN

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD)-related disorders of systemic sclerosis (SSc) patients have not been adequately investigated. METHODS: Sixty-six SSc patients (5 males and 61 females; 56.6 ± 14.6 years old) who underwent esophagogastroduodenoscopy were analyzed on the basis of 16 background factors. They were additionally compared with 116 matched non-SSc subjects controlling age, sex, and use of proton pump inhibitors (PPIs). RESULTS: The mean disease duration of 66 patients was 5.1 ± 8.1 years, and their breakdown was as follows: 53 (80.3%) with GERD, 38 (57.6%) with GERD-related symptoms, and 20 (30.3%) with reflux esophagitis (RE; LA-A: 10, LA-B: 5, LA-C: 4, LA-D: 1). Use of PPI (p = 0.0455), complication of interstitial lung disease (p = 0.0242), and history of cyclophosphamide therapy (p = 0.0184) denoted significant association with GERD-related symptoms. Older age (p = 0.0211) was significantly associated with RE. None of GERD-related disorders showed any difference between 37 diffuse cutaneous SSc and 29 limited cutaneous SSc patients. The matched analysis indicated that SSc patients had higher prevalence of GERD (p < 0.0001), GERD-related symptoms (p = 0.0034), and RE (p = 0.0002). CONCLUSION: SSc patients tend to have worse GERD symptoms and severer RE. However, most SSc-associated factors did not show significant association with GERD-related disorders, indicating the difficulty in predicting GERD-related disorders among SSc patients.


Asunto(s)
Reflujo Gastroesofágico/epidemiología , Inhibidores de la Bomba de Protones/uso terapéutico , Esclerodermia Sistémica/complicaciones , Adulto , Factores de Edad , Anciano , Estudios de Casos y Controles , Endoscopía del Sistema Digestivo , Femenino , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/tratamiento farmacológico , Reflujo Gastroesofágico/etiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento
20.
Dig Dis Sci ; 63(10): 2617-2625, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29956011

RESUMEN

BACKGROUND: Sporadic nonampullary duodenal epithelial tumors (NADETs) are uncommon, and thus their clinicopathological features have not been fully assessed. AIMS: In this study, we have analyzed a series of early sporadic NADETs, focusing on various immunohistological features. METHODS: We conducted a multicenter retrospective analysis of 68 patients with endoscopically resected sporadic NADETs. Associations between immunohistological features and clinicopathological features were statistically analyzed. RESULTS: The 68 patients consisted of 46 men (68%) and 22 women (32%) with a mean age of 60.7 ± 12.2 years (range 37-85 years). The 68 tumors were composed of 39 adenomas (57%) and 29 early-stage adenocarcinomas (43%). Duodenal adenocarcinomas were larger in size than adenomas and had papillary architecture in their pathological diagnosis with statistical significance. Duodenal adenocarcinomas also demonstrated a significantly higher expression of gastric markers (MUC5AC and MUC6) and a higher MIB-1 index. Duodenal adenomas were contrastively apt to express intestinal markers (MUC2, CDX1 and CDX2). Of the 68 cases analyzed, there were only 3 tumors positive for p53 staining, all of which were adenocarcinoma. When 7 submucosal invasive cancers and 21 intramucosal cancers were compared, submucosal invasion was positively associated with expression of MUC5AC. Also, submucosal invasion showed strong association with double-positivity of MUC5AC and MUC6. CONCLUSIONS: Our results indicate that immunohistochemical evaluation is useful for predicting malignant potential of NADETs, especially focusing on the expression of gastrointestinal markers.


Asunto(s)
Adenocarcinoma , Adenoma , Neoplasias Duodenales , Endoscopía del Sistema Digestivo/métodos , Proteínas de Homeodominio/análisis , Mucina 5AC/análisis , Mucina 2/análisis , Mucina 6/análisis , Adenocarcinoma/epidemiología , Adenocarcinoma/metabolismo , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adenoma/metabolismo , Adenoma/patología , Anciano , Biomarcadores de Tumor/metabolismo , Neoplasias Duodenales/epidemiología , Neoplasias Duodenales/metabolismo , Neoplasias Duodenales/patología , Neoplasias Duodenales/cirugía , Duodeno/patología , Duodeno/cirugía , Femenino , Humanos , Inmunohistoquímica , Japón/epidemiología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Estadística como Asunto
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