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Efficacy of endoluminal gastroplication in Japanese patients with proton pump inhibitor-resistant,non-erosive esophagitis

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World Journal of Gastroenterology 2012年第41期18卷 5940-5947页

作者： Kentaro Tokudome Yasushi Funaki Makoto Sasaki Shinya Izawa Yasuhiro Tamura Akihito Iida Naotaka Ogasawara Toshihiro Konagaya Yoshifumi Tokura kunio kasugai Division of Gastroenterology Department of Internal MedicineAichi Medical University School of MedicineAichi 480-1195Japan Department of Clinical Laboratory Aichi Medical University School of MedicineAichi 480-1195Japan Marine Clinic NagoyaAichi 460-0002Japan Tokura Yoshifumi Stomach and Intestines Internal Medicine Clinic Kyoto 615-8256Japan

AIM： To evaluate the efficacy, safety, and long-term outcomes of endoluminal gastroplication （ELGP） in pa- tients with proton pump inhibitor （PPI）-resistant, non- erosive reflux disease （NERD）. METHODS： The subjects were NERD patients, diag- nosed by upper endoscopy before PPI use, who had symptoms such as heartburn or reflux sensations two or more times a week even after 8 wk of full-dose PPI treatment. Prior to ELGP, while continuing full-dose PPImedication, patients＇ symptoms and quality of life （QOL） were assessed using the questionnaire for the diagno- sis of reflux disease, the frequency scale for symptoms of gastro-esophageal reflux disease （FSSG）, gastroin- testinal symptoms rating scale, a 36-item short-form. In addition, 24-h esophageal pH monitoring or 24-h in- traesophageal pH/impedance （MII-pH） monitoring was performed. The Bard EndoCinchTM was used for ELGP, and 2 or 3 plications were made. After ELGP, all acid reducers were temporarily discontinued, and medica- tion was resumed depending on the development and severity of symptoms. Three mo after ELGP, symptoms, QOL, pH or MII-pH monitoring, number of plications, and PPI medication were evaluated. Further, symptoms, number of plications, and PPI medication were evalu- ated 12 mo after ELGP to investigate long-term effects. RESULTS： The mean FSSG score decreased signifi- cantly from before ELGP to 3 and 12 mo after ELGP （19.1 ：k 10.5 to 10.3 ＋ 7.4 and 9.3 ＋ 9.9, P 〈 0.05, respectively）. The total number of plications decreased gradually at 3 and 12 mo after ELGP （2.4 ＋ 0.8 to 1.2 ：l： 0.8 and 0.8 ：l： 1.0, P 〈 0.05, respectively）. The FSSG scores in cases with no remaining plications and in cases with one or more remaining plications were 4.4 and 2.7, respectively, after 3 too, and 2.0 and 2.8, respectively, after 12 mo, showing no correlation to plication loss. On pH monitoring, there was no differ- ence in the percent time pH 〈 4 from before ELGP to 3 mo after. Impedance monitoring revealed no changes

关键词： Endoluminal gastroplication EsophagealpH Gastro-esophageal reflux disease Non-erosive re-flux disease Proton pump inhibitor-resistant

Inhibition of gastric perception of mild distention by omeprazole in volunteers

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World Journal of Gastroenterology 2012年第39期18卷 5576-5580页

作者： Akihito Iida Hiroshi Kaneko Toshihiro Konagaya Yasushi Funaki Kentaro Tokudome Shinya Izawa Yasuhiro Tamura Mari Mizuno Naotaka Ogasawara Makoto Sasaki kunio kasugai Division of Gastroen-terology Department of Internal MedicineSchool of MedicineAichi Medical UniversityAichi 480-1195Japan Department of Internal Medicine Hoshigaoka Maternity HospitalAichi 464-0026Japan Marine Clinic NagoyaAichi 460-0002Japan

AIM： To evaluate the effects of omeprazole on gastric mechanosensitivity in humans. METHODS： A double lumen polyvinyl tube with a plas- tic bag was introduced into the stomach of healthy volunteers under fluorography and connected to a barostat device. Subjects were then positioned so they were sitting comfortably, and the minimal distending pressure （MDP） was determined after a 30-rain adap- tation period. Isobaric distensions were performed in stepwise increments of 2 mmHg （2 min each） starting from the MDR Subjects were instructed to score feel- ings at the end of every step using a graphic rating scale： 0, no perception; 1, weak/vague; 2, weak but significant; 3, moderate/vague; 4, moderate but signifi- cant; 5, severe discomfort; and 6, unbearable pain. Af- ter this first test, subjects received omeprazole （20 mg, after dinner） once daily for 1 wk. A second test was performed on the last day of treatment. RESULTS： No adverse effects were observed. Mean MDP before and after treatment was 6.3 - 0.3 mmHg and 6.2：1：0.5 mmHg, respectively. One subject before and 2 after treatment did not reach a score of 6 at the maximum bag volume of 750 mL. After omeprazole, there was a significant increase in the distension pres- sure required to reach scores of 1 （P = 0.019） and 2 （P = 0.017） as compared to baseline. There were no changes in pressure required to reach the other scores after treatment. Two subjects before and one after omeprazole rated their abdominal feeling 〈 1 at MDP, and mean （±SE） abdominal discomfort scores at MDP were 0.13±0.09 and 0.04±0.04, respectively. Mean scores induced by each MDP ＋ 2, 4, 6, 8, 10, 12, 14, 16, 18 and 20 （mmHg） were 1.1±0.3, 2.0±0.4, 2.9±0.5, 3.3±0.4, 4.6±0.3, 5.2±0.3, 5.5±0.2, 5.5±0.3, 5.7±0.3, and 5.4, respectively. After omepra- zole, abdominal feeling scores for the same incremen- tal pressures over MDP were 0.3±0.1, 0.8±0.1, 2.0±0.4, 2.8±0.4, 3.8±0.4, 4.6±0.4, 4.9±0.3, 5.4±0.4, 5.2±0.6, and 5.0±1.0, respectively. A signif- icant

关键词： Functional dyspepsia Acid exposure Ome-prazole Barostat test Mechanosensitivity

Gastric calcifying fibrous tumor removed by endoscopic submucosal dissection

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World Journal of Gastrointestinal Endoscopy 2013年第9期5卷 457-460页

作者： Naotaka Ogasawara Shinya Izawa Mari Mizuno Atsushi Tanabe Tomonori Ozeki Hisatsugu Noda Emiko Takahashi Makoto Sasaki Toyoharu Yokoi kunio kasugai Department of Gastroenterology Aichi Medical University School of Medicine Department of Pathology Aichi Medical University School of Medicine

The World Health Organization describes calcifying fibrous tumors(CFTs) as rare, benign lesions characterized by hypocellular, densely hyalinized collagenization with lymphoplasmacytic infiltration. These tumors rarely involve the gastrointestinal(GI) tract. A routine endoscopic upper gastrointestinal screen detected a 10-mm submucosal tumor(SMT) in the lesser curvature of the lower corpus of the stomach of an apparently healthy, 37-year-old woman with no history of Helicobacter pylori infection. Endoscopic ultrasonography(EUS) localized the internally isoechoic, homogeneous SMT mainly within the submucosa. Malignancy was ruled out using endoscopic submucosal dissection(ESD). A pathological examination confirmed complete resection of the SMT, and defined a hypocellular, spindle-cell tumor with a densely hyalinized, collagenous matrix, scattered lymphoplasmacytic aggregates as well as a few psammomatous, dystrophic calcified foci. The mass was immunohistochemically positive for vimentin and negative for CD117(c-kit protein), CD34, desmin, smooth muscle actin(SMA) and S100. Therefore, the histological findings were characteristic of a CFT. To date, CFT resection by ESD has not been described. This is the first case report of a gastric calcifying fibrous tumor being completely resected by ESD after endoscopic ultrasonography.

关键词： Calcifying fibrous tumor Endoscopic submucosal dissection Submucosal tumor Endoscopic ultrasonography

Pathophysiology of functional heartburn based on Rome Ⅲ criteria in Japanese patients

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World Journal of Gastroenterology 2015年第16期21卷 5009-5016页

作者： Yasuhiro Tamura Yasushi Funaki Shinya Izawa Akihito Iida Yoshiharu Yamaguchi Kazunori Adachi Naotaka Ogasawara Makoto Sasaki Hiroshi Kaneko kunio kasugai Department of Gastroenterology Division of Internal MedicineAichi Medical University School of Medicine Department of Clinical Laboratory Aichi Medical University School of Medicine Department of Internal Medicine Hoshigaoka Maternity Hospital

AIM:To investigate the pathophysiology of functional heartburn(FH) in Japanese ***:A total of 111 patients with proton pump inhibitor(PPI)-refractory non-erosive gastroesophageal reflux disease underwent intraesophageal pressure testing and 24-h multichannel intraluminal impedancep H(24MII-p H) *** patients also completed several questionnaires while they were receiving the PPI treatment, including the questionnaire for the diagnosis of reflux disease(QUEST), the frequency scale for the symptoms of gastroesophageal reflux disease(FSSG), the gastrointestinal symptoms rating scale(GSRS), SF-36, and the Cornell Medical Index(CMI).The subjects were classified into FH and endoscopy-negative reflux disease(ENRD) groups based on the Rome Ⅲ ***:Thirty-three patients with esophageal motility disorder were excluded from this study, while 22 patients with abnormal esophageal acid exposure time(p H-POS) and 34 with hypersensitive esophagus(HE) were included in the ENRD *** FH group included 22 patients with no reflux ***, age, and body mass index did not differ significantly between the *** mean SF-36 values were < 50(normal) for all scales in these groups, with no significant *** GSRS scores in these groups were not different and showed overlap with other gastrointestinal *** QUEST and the FSSG scores did not differ significantly between the *** was diagnosed using the CMI questionnaire in 17 of the 78 included subjects within the p H-POS(n=4),HE(n=8),and FH(n=5)groups,with no significant ***:Clinical characteristics of the FH and PPI-refractory ENRD groups were ***,esophageal function should be examined via manometry and 24MII-p H testing to differentiate between them.

关键词： Functional heartburn endoscopy-negativereflux disease proton pump inhibitor-resistant RomeⅢ criteria 24-h multichannel intraluminal impedancepHtesting