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Comparative study: Vonoprazan and proton pump inhibitors in Helicobacter pylori eradication therapy

World Journal of Gastroenterology 2017年第4期23卷 668-675页

作者： kouichi sakurai Hiroko Suda Yumi Ido Takayuki Takeichi Ayako Okuda Kiwamu Hasuda Masahiro Hattori Hattori Clinic Chuo-ku

AIMTo compare the effectiveness and safety of vonoprazan-based therapy with proton pump inhibitor (PPI)-based therapies to treat Helicobacter pylori (H. pylori).METHODSWe retrospectively analysed data from first-line (vonoprazan or PPI with 200 mg clarithromycin and 750 mg amoxicillin twice daily for 7 d) (n = 1353) and second-line (vonoprazan or PPI with 250 mg metronidazole and 750 mg amoxicillin twice daily for 7 d) (n = 261) eradication treatments for H. pylori -positive patients with associated gastrointestinal diseases from April 2014 to December 2015 at Hattori Clinic, Japan. The primary endpoint was the eradication rate, which was assessed with a full analysis set. The secondary endpoints were adverse events and related *** the first-line treatments, the eradication rates for vonoprazan, esomeprazol, rabeprazole, and lansoprazole were 87.9% (95%CI: 84.9%-90.5%), 71.6% (95%CI: 67.5%-75.5%), 62.9% (95%CI: 52.0%-72.9%), and 57.3% (95%CI: 50.4%-64.1%), respectively. The vonoprazan eradication rate was significantly higher than that of the PPIs (P < 0.01). Interestingly, smoking did not affect the H. pylori eradication rate in the vonoprazan group (P = 0.34), whereas it decreased the rates in the PPI groups (P = 0.013). The incidence of adverse events in the vonoprazan group was not different from the PPI group (P = 0.054), although the vonoprazan group exhibited a wider range of adverse events. Vonoprazan-based triple therapy was highly effective as a second-line treatment, with an eradication rate similar to that of PPI-based *** might be superior to PPIs in first-line H. pylori therapy, particularly for smokers. However, caution is required due to possible adverse events.

关键词： Helicobacter pylori Eradication treatment Vonoprazan Proton pump inhibitors Adverse event Smoking

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Factors associated with complicated erosive esophagitis: A Japanese multicenter, prospective, cross-sectional study

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World Journal of Gastroenterology 2017年第2期23卷 318-327页

作者： Masahiro Sakaguchi Noriaki Manabe Nobuo Ueki Jun Miwa Tomoki Inaba Norimasa Yoshida kouichi sakurai Masahiro Nakagawa Hajime Yamada Michiya Saito Koji Nakada Katsuhiko Iwakiri Takashi Joh Ken Haruma Department of Gastroenterology Moriguchi Keijinkai Hospital Division of Endoscopy and Ultrasonography Department of Clinical Pathology and Laboratory MedicineKawasaki Medical School Department of Internal Gastroenterology and Hepatology Tokyo Rosai Hospital Department of Gastroenterology Toshiba General Hospital Department of Gastroenterology Kagawa Prefectural Central Hospital Department of Gastroenterology Japanese Red Cross Kyoto Daiichi Hospital Hattori Clinic Department of Endoscopy Hiroshima City Hospital Department of Gastroenterology and Hepatology Shinko Hospital1 Michiya Clinic1 Department of Laboratory Medicine Daisan Hospital Jikei University School of Medicine1 Department of Gastroenterology Nippon Medical School Graduate School of Medicine1 Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Sciences1 Department of General Internal Medicine 2 Kawasaki Medical School General Medical Center

AIMTo assess the clinical characteristics of patients with complicated erosive esophagitis (EE) and their associated *** prospective, cross-sectional study included patients diagnosed with EE by upper gastrointestinal endoscopy between October 2014 and March 2015 at 106 Japanese hospitals. Data on medical history, general condition, gastrointestinal symptoms, lifestyle habits, comorbidities, and endoscopic findings were collected using a standard form to create a dedicated database. Logistic regression analysis was used to calculate adjusted odds ratios (aOR) and 95%CI for the association with complicated *** the study period, 1749 patients diagnosed with EE, 38.3% of whom were prescribed proton pump inhibitors (PPIs) were included. Of them, 143 (8.2%) had EE complications. Esophageal bleeding occurred in 84 (4.8%) patients, esophageal strictures in 45 (2.6%) patients, and 14 (0.8%) patients experienced both. Multivariate analysis showed that increased age (aOR: 1.05; 95%CI: 1.03-1.08), concomitant use of psychotropic agents (aOR: 6.51; 95%CI: 3.01-13.61), and Los Angeles grades B (aOR: 2.69; 95%CI: 1.48-4.96), C (aOR: 15.38; 95%CI: 8.62-28.37), and D (aOR: 71.49; 95%CI: 37.47-142.01) were significantly associated with complications, whereas alcohol consumption 2-4 d/wk was negatively associated (aOR: 0.23; 95%CI: 0.06-0.61). Analyzing associated factors with each EE complication separately showed esophageal ulcer bleeding were associated with increased age (aOR: 1.05; 95%CI: 1.02-1.07) and Los Angeles grades B (aOR: 3.60; 95%CI: 1.52-8.50), C (aOR: 27.61; 95%CI: 12.34-61.80), and D (aOR: 119.09; 95%CI: 51.15-277.29), while esophageal strictures were associated with increased age (aOR: 1.07; 95%CI: 1.04-1.10), gastroesophageal reflux symptom (aOR: 2.51; 95%CI: 1.39-4.51), concomitant use of psychotropic agents (aOR: 11.79; 95%CI: 5.06-27.48), Los Angeles grades C (aOR: 7.35; 95%CI: 3.32-16.25), and D (aOR: 20.34; 95%CI: 8.36-49.53) and l

关键词： Complication Erosive esophagitis Proton pump inhibitor Esophageal ulcer bleeding Esophageal stricture

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A case of gastric mucosa-associated lymphoid tissue lymphoma in which magnified endoscopy with narrow band imaging was useful in the diagnosis

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World Journal of Gastrointestinal Endoscopy 2012年第4期4卷 151-156页

作者： kouichi Nonaka Keiko Ishikawa Shin Arai Masamitsu Nakao Michio Shimizu Takaki sakurai Koji Nagata Makoto Nishimura Osamu Togawa Yasutoshi Ochiai Yutaka Sasaki Hiroto Kita Department of Gastroenterology Saitama Medical University International Medical Center Saitama 350-1298 Japan Department of Pathology Saitama Medical University International Medical Center Saitama 350-1298 Japan Department of Gastroenterology and Hepatology Graduate School of Medical Sciences Kumamoto University Kumamoto 860-8556 Japan

Recently, we reported a case of gastric mucosaassociated lymphoid tissue (MALT) lymphoma presenting with unique vascular features. In the report, we defined the tree-like appearance (TLA) on the images of abnormal blood vessels which resembled branches from the trunk of a tree in the shiny mucosa, in which the glandular structure was lost. The 67-year-old female was diagnosed with gastric MALT lymphoma. The patient received eradication therapy for H. pylori. Conventional endoscopy revealed multiple ill-delineated brownish depressions in the stomach and cobblestonelike mucosa was observed at the greater curvature to the posterior wall of the upper gastric body 7 mo after successful eradication. Unsuccessful treatment of gastric MALT lymphoma was suspected on conventional endoscopy. Conventional endoscopic observations found focal depressions and cobblestone-like appearance, and these lesions were subsequently observed using magnified endoscopy combined with narrow band imaging to identify abnormal vessels presenting with a TLA within the lesions. Ten biopsies were taken from the area where abnormal vessels were present within these lesions. Ten biopsies were also taken from the lesions without abnormal vessels as a control. A total of 20 biopsy samples were evaluated to determine whether the diagnosis of MALT lymphoma could be obtained histologically from each sample. A positive diagnosis was obtained in 8/10 TLA (+) sites and in 2/10 TLA(-) sites. Target biopsies of the site with abnormal blood vessels can potentially improve diagnostic accuracy of gastric MALT lymphoma.

关键词： Mucosa associated-lymphoid tissue Magnified endoscopy Narrow band imaging Tree-like appearance

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