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Clinical differentiation of acute appendicitis and right colonic diverticulitis: A case-control study

World Journal of Clinical Cases 2019年第12期7卷 1393-1402页

作者： Yosuke Sasaki fumiya komatsu Naoyasu Kashima Takahiro Sato Ikutaka Takemoto Sho Kijima Tadashi Maeda Takamasa Ishii Taito Miyazaki Yoshiko Honda Nagato Shimada Yoshihisa Urita Department of General Medicine and Emergency Care Toho University School of Medicine

BACKGROUND Acute right colonic diverticulitis (ARCD) is an important differential diagnosis of acute appendicitis (AA) in Asian countries because of the unusually high prevalence of right colonic diverticula. Due to qualitative improvement and the high penetration rate of computed tomography (CT) scanning in Japan, differentiation of ARCD and AA mainly depends on this modality. But cost, limited availability, and concern for radiation exposure make CT scanning problematic. Differential findings of ARCD from AA are based on several small studies that used univariate comparisons from Korea and Taiwan. Previous studies on clinical and laboratory differences between AA and ARCD are limited. AIM To determine clinical differences between AA and ARCD for differentiation of these two diagnoses by creating a logistic regression model. METHODS We performed an exploratory single-center retrospective case-control study evaluating 369 Japanese patients (age ≥ 16 years), 236 (64.0%) with AA and 133 (36.0%) with ARCD, who were hospitalized between 2012 and 2016. Diagnoses were confirmed by CT images. We compared age, sex, onset-to-visit interval, epigastric/periumbilical pain, right lower quadrant (RLQ) pain, nausea/vomiting, diarrhea, anorexia, medical history, body temperature, blood pressure, heart rate, RLQ tenderness, peritoneal signs, leukocyte count, and levels of serum creatinine, serum C-reactive protein (CRP), and serum alanine aminotrans-ferase. We subsequently performed logistic regression analysis for differentiating AA from ARCD based on the results of the univariate *** In the AA and ARCD groups, median ages were 35.5 and 41.0 years, respectively (p=0.011);median onset-to-visit intervals were 1 [interquartile range (IQR): 0-1] and 2 (IQR: 1-3) days, respectively (P < 0.001);median leukocyte counts were 12600 and 11500/mm3, respectively (P = 0.002);and median CRP levels were 1.1 (IQR: 0.2-4.1) and 4.9 (IQR: 2.9-8.5) mg/dL, respectively (P < 0.001). In th

关键词： Abdominal pain Acute abdomen Appendicitis Clinical difference Creactive protein Diverticulitis Right lower quadrant pain

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Clinical prediction of complicated appendicitis:A case-control study utilizing logistic regression

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World Journal of Clinical Cases 2020年第11期8卷 2127-2136页

作者： Yosuke Sasaki fumiya komatsu Naoyasu Kashima Takeshi Suzuki Ikutaka Takemoto Sho Kijima Tadashi Maeda Taito Miyazaki Yoshiko Honda Hiroaki Zai Nagato Shimada Kimihiko Funahashi Yoshihisa Urita Department of General Medicine and Emergency Care Toho University School of MedicineOta-kuTokyo 143-8541Japan Department of General and Gastroenterological Surgery Toho University Omori Medical CenterOtakuTokyo 143-8541Japan

BACKGROUND Since high-quality evidence on conservative treatment of acute appendicitis using antibiotics has increased,differentiation of patients with complicated appendicitis(CA)from those with simple appendicitis(SA)has become increasingly *** studies have revealed that male gender,advanced age,comorbid conditions,prehospital delay,fever,and anorexia are risk factors of perforated *** serum C-reactive protein(CRP)level and hyponatremia have also been reported as predictive biomarkers of ***,confounding between various factors is problematic because most previous studies were limited to univariate *** To evaluate non-laboratory and laboratory predictive factors of CA using logistic regression *** We performed an exploratory,single-center,retrospective case-control study that evaluated 198 patients(83.9%)with SA and 38 patients(16.1%)with *** were confirmed by computed tomography images for all *** compared age,sex,onset-to-visit interval,epigastric/periumbilical pain,right lower quadrant pain,nausea/vomiting,diarrhea,anorexia,medical history(of previous non-surgically treated appendicitis,diabetes,hypertension,dyslipidemia,liver cirrhosis,hemodialysis,chronic lung diseases,malignant tumors,immunosuppressant use,and antiplatelet use),vital signs,physical findings,and laboratory data to select the explanatory variates for logistic *** on the univariate comparisons,we performed logistic regression for clinical differentiation between CA and SA using only nonlaboratory factors and also including both non-laboratory and laboratory *** The 236 eligible patients consisted of 198 patients(83.9%)with SA and 38 patients(16.1%)with *** median ages were 34 years old[interquartile ranges(IR),24-45 years]in the SA group and 49 years old(IR,35-63 years)in the CA group(P<0.001).The median onset-to-visit interval was 1 d(IR,0-1)and 1 d(IR,1-2)in the SA and CA groups,respectively

关键词： Acute abdomen Abscess Appendicitis C-reactive protein Forecasting Intestinal perforation

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Randomized study of lafutidine vs lansoprazole in patients with mild gastroesophageal reflux disease

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World Journal of Gastroenterology 2016年第23期22卷 5430-5435页

作者： Ryuta Takenaka Hiroyuki Okada Seiji Kawano Yoshinori Komazawa fumiya Yoshinaga Shinji Nagata Masafumi Inoue Hirohisa komatsu Seiji Onogawa Yoshinori Kushiyama Shinichi Mukai Hiroko Todo Hideharu Okanobu Noriaki Manabe Shinji Tanaka Ken Haruma Yoshikazu Kinoshita Department of Gastroenterology Tsuyama Chuo Hospital Tsuyama 708-0841 Japan Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Okayama 708-0841 Japan Division of Internal Medicine Izumo City General Medical Center Izumo 691-0003 Japan Department of Gastroenterology Mihara Red Cross Hospital Mihara 723-0011 Japan Department of Endoscopy Hiroshima City Asa Citizens Hospital Hiroshima 731-0293 Japan Department of Gastroenterology Okayama Red Cross Hospital Okayama 700-0941 Japan Department of Gastroenterology Hiroshima General Hospital Hiroshima 734-8551 Japan Department of Gastroenterology Onomichi General Hospital Onomichi 722-8508 Japan Department of Gastroenterology Matsue Red Cross Hospital Matsue 690-8506 Japan Department of Gastroenterology Miyoshi Central Hospital Miyoshi 728-0023 Japan Department of Gastroenterology Hiroshima-Nishi Medical Center Hiroshima 739-0651 Japan Department of Gastroenterology Chugoku Rosai Hospital Kure 737-0134 Japan Department of Gastroenterology Kawasaki Medical School Hospital Kurashiki 701-0192 Japan Department of Endoscopy Hiroshima University Hospital Hiroshima 734-8551 Japan Department of General Internal Medicine 2 Kawasaki Hospital Kawasaki Medical School Okayama 708-0841 Japan Department of Gastroenterology and Hepatology Shimane University Hospital Izumo 693-0021 Japan

AIM: To compare the clinical efficacy of the secondgeneration H2 RA lafutidine with that of lansoprazole in Japanese patients with mild gastroesophageal reflux disease(GERD). METHODS: Patients with symptoms of GERD and a diagnosis of grade A reflux esophagitis(according to the Los Angeles classification) were randomized to receive lafutidine(10 mg, twice daily) or lansoprazole(30 mg, once daily) for an initial 8 wk, followed by maintenance treatment comprising half-doses of the assigned drug for 24 wk. The primary endpoint was the frequency and severity of heartburn during initial and maintenance treatment. The secondary endpoints were the sum score of questions 2 and 3 in the Gastrointestinal Symptom Rating Scale(GSRS), and the satisfaction ***: Between April 2012 and March 2013, a total of 53 patients were enrolled, of whom 24 and 29 received lafutidine and lansoprazole, respectively. After 8 wk, the frequency and severity of heartburn was significantly reduced in both groups. However, lafutidine was significantly inferior to lansoprazole with regard to the severity of heartburn during initial and maintenance treatment(P = 0.016). The sum score of questions 2 and 3 in the GSRS, and satisfaction scores were also significantly worse in the lafutidine group than the lansoprazole group(P = 0.0068 and P = 0.0048, respectively).CONCLUSION: The clinical efficacy of lafutidine was inferior to that of lansoprazole, even in Japanese patients with mild GERD.

关键词： Gastroesophageal reflux disease Proton pump inhibitors Histamine receptor-2 antagonists Los Angeles classification

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