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Considerations of elderly factors to manage the complication of liver cirrhosis in elderly patients

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World Journal of Gastroenterology 2019年第15期25卷 1817-1827页

作者： kenya kamimura Akira Sakamaki Hiroteru kamimura Toru Setsu Takeshi Yokoo Masaaki Takamura Shuji Terai Division of Gastroenterology and Hepatology Graduate School of Medical and Dental Sciences Niigata University

The aging of the organ function causes sensitivity to the disease progression and need careful consideration for the medical treatment. With the increase of aging population, the opportunity to provide medical treatment for people in very old age is rapidly increasing therefore, the understanding of the various physiological changes of cellular function, size and function of organs are essential for the decision of therapeutic options. Among the various chronic conditions seen in elderly people, we have focused on liver cirrhosis, since despite specific therapeutic options for many of liver diseases including direct acting antivirals for hepatitis C virus, nucleoside analogs for hepatitis B, and corticosteroids for autoimmune hepatitis, there is currently no standard therapy to treat liver cirrhosis, which is the final stage of these liver diseases. Therefore,management of the various symptoms of liver cirrhosis is essential, and agingrelated parameters must be considered in the decision making for therapeutic strategies and dosage of the available medicine. In this mini-review, we have summarized the therapeutic options to manage various symptoms of liver cirrhosis, carefully considering the physiological changes of various organs associated with aging.

关键词： Liver cirrhosis Elderly patients Quality of life Aging

Advances in understanding and treating liver diseases during pregnancy:A review

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World Journal of Gastroenterology 2015年第17期21卷 5183-5190页

作者： kenya kamimura Hiroyuki Abe Hirokazu Kawai Hiroteru kamimura Yuji Kobayashi Minoru Nomoto Yutaka Aoyagi Shuji Terai Division of Gastroenterology and Hepatology Graduate School of Medical and Dental SciencesNiigata UniversityNiigata 951-8510Japan

Liver disease in pregnancy is rare but pregnancyrelated liver diseases may cause threat to fetal and maternal *** includes pre-eclampsia;eclampsia;haemolysis,elevated liver enzymes,and low platelets syndrome;acute fatty liver of pregnancy;hyperemesis gravidarum;and intrahepatic cholestasis of *** basic researches have shown the various etiologies involved in this disease *** these advances,rapid diagnosis is essential for severe cases since the decision of immediate delivery is important for maternal and fetal *** other therapeutic options have also been shown in recent reports based on the clinical trials and cooperation and information sharing between hepatologist and gynecologist is important for timely therapeutic ***,correct understandings of diseases and differential diagnosis from the pre-existing and co-incidental liver diseases during the pregnancy will help to achieve better ***,here we review and summarized recent advances in understanding the etiologies,clinical courses and management of liver disease in *** information will contribute to physicians for diagnosis of disease and optimum management of patients.

关键词： Pregnancy Liver injury Low platelets Haemolysis elevated liver enzymes Acute fatty liverof pregnancy Hyperemesis gravidarum Intrahepaticcholestasis of pregnancy

Natural regression of fibrosis in chronic hepatitis B

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World Journal of Gastroenterology 2016年第24期22卷 5459-5466页

作者： Shogo Ohkoshi Haruka Hirono Kazuhiko Watanabe Katsuhiko Hasegawa kenya kamimura Masahiko Yano Department of Internal Medicine School of Life Dentistry at Niigata The Nippon Dental University Division of Gastroenterology and Hepatology Graduate School of Medical and Dental Sciences Niigata University

The fibrosis of liver cirrhosis was considered to be irreversible before the anti-viral drugs showed that it is reversible when they lead to continuous suppression of viral replication and inflammation. However, several reports previously showed that fibrosis of type B liver cirrhosis was almost completely absorbed after the natural remission of chronic inflammation. This phenomenon might not be limited to exceptional patients, but rather occur commonly, considering the dynamic clinical features of chronic hepatitis B(CHB), where inactive carrier stage normally follows aggravation of hepatitis and progression of fibrosis at the time of HBe Ag seroconversion. Thus, fibrosis levels of CHB as a hepatocellular carcinoma(HCC)-surveillance marker, particularly those of the inactive stage, could be underestimated, because some of them might have been(pre)cirrhotic in the past and recovered with the natural regression of fibrosis. We argue that cirrhosisinduced HCC mechanisms, rather than direct action of viral genome, may be more common than generally considered in CHB patients. This may have some impact on reconsidering the surveillance rationale for HCC in CHB, from where advanced HCCs tended to be missed. In addition, a molecular marker to assess the cancer-prone characteristics of the liver will definitely be needed to resolve the issue.

关键词： Chronic hepatitis B Cirrhosis Spontaneous remission Regression of fibrosis Occult hepatitis B infection Hepatocellular carcinoma surveillance of hepatitis B virus

Diversion colitis and pouchitis: A mini-review

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World Journal of Gastroenterology 2018年第16期24卷 1734-1747页

作者： Kentaro Tominaga kenya kamimura Kazuya Takahashi Junji Yokoyama Satoshi Yamagiwa Shuji Terai Division of Gastroenterology and Hepatology Graduate School of Medical and Dental Sciences Niigata University

Diversion colitis is characterized by inflammation of the mucosa in the defunctioned segment of the colon after colostomy or ileostomy. Similar to diversion colitis, diversion pouchitis is an inflammatory disorder occurring in the ileal pouch, resulting from the exclusion of the fecal stream and a subsequent lack of nutrients from luminal bacteria. Although the vast majority of patients with surgically-diverted gastrointestinal tracts remain asymptomatic, it has been reported that diversion colitis and pouchitis might occur in almost all patients with diversion. Surgical closure of the stoma, with reestablishment of gut continuity, is the only curative intervention available for patients with diversion disease. Pharmacologic treatments using short-chain fatty acids, mesalamine, or corticosteroids are reportedly effective for those who are not candidates for surgical reestablishment; however, there are no established assessment criteria for determining the severity of diversion colitis, and no management strategies to date. Therefore, in this mini-review, we summarize and review various recently-reported treatments for diversion disease. We are hopeful that the information summarized here will assist physicians who treat patients with diversion colitis and pouchitis, leading to better case management.

关键词： Diversion colitis Diversion pouchitis Ileitis Inflammatory bowel disease

Diagnosis and management of fibromuscular dysplasia and segmental arterial mediolysis in gastroenterology field: A mini-review

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World Journal of Gastroenterology 2018年第32期24卷 3637-3649页

作者： Masayoshi Ko kenya kamimura Kohei Ogawa Kentaro Tominaga Akira Sakamaki Hiroteru kamimura Satoshi Abe Kenichi Mizuno Shuji Terai Division of Gastroenterology and Hepatology Graduate School of Medical and Dental Sciences Niigata University

The vascular diseases including aneurysm, occlusion, and thromboses in the mesenteric lesions could cause severe symptoms and appropriate diagnosis and treatment are essential for managing patients. With the development and improvement of imaging modalities, diagnostic frequency of these vascular diseases in abdominal lesions is increasing even with the small changes in the vasculatures. Among various vascular diseases, fibromuscular dysplasia(FMD) and segmental arterial mediolysis(SAM) are noninflammatory, nonatherosclerotic arterial diseases which need to be diagnosed urgently because these diseases could affect various organs and be lethal if the appropriate management is not provided. However, because FMD and SAM are rare, the cause, prevalence, clinical characteristics including the symptoms, findings in the imaging studies, pathological findings, management, and prognoses have not been systematically summarized. Therefore, there have been neither standard diagnostic criteria nor therapeutic methodologies established, to date. To systematically summarize the information and to compare these disease entities, we have summarized the characteristics of FMD and SAM in the gastroenterological regions by reviewing the cases reported thus far. The information summarized will be helpful for physicians treating these patients in an emergency care unit and for the differential diagnosis of other diseases showing severe abdominal pain.

关键词： Fibromuscular dysplasia Segmental arterial mediolysis Mesenteric lesion diagnosis Humans

Autonomic nervous system network and liver regeneration

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World Journal of Gastroenterology 2018年第15期24卷 1616-1621页

作者： kenya kamimura Ryosuke Inoue Takuro Nagoya Norihiro Sakai Ryo Goto Masayoshi Ko Yusuke Niwa Shuji Terai Division of Gastroenterology and Hepatology Graduate School of Medical and Dental Sciences Niigata University

To date, various signal transducers, cytokines, growth factors, and hormones have been reported to play an important role in homeostasis of various organs. Various cells and organs are involved in the hepatic regeneration process, which proceeds as a result of the coordination of many factors. While these factors are well known to be involved in the liver regeneration after the liver injury, however, as the details of such mechanisms have not been sufficiently elucidated, the practical applicability of hepatic regeneration based on the action of these and cytokines growth factors is still unclear. In terms of the involvement of the autonomic nervous system in hepatic regeneration, cell proliferation resulting from direct signal transduction to the liver has also been reported and recent studies focusing on the inter-organ communication via neural network opened a novel aspect of this field for therapeutic applicability. Therefore, the appropriate understanding of the relationship between autonomic neural network and liver regeneration through various organs including brain, afferent nerve, efferent nerve, etc. is essential. This mini-review explains the principle of neural system involved in the inter-organ communication and its contribution on the liver regeneration upon the liver injury reviewing recent progress in this field.

关键词： Autonomic nerve Neural network Liver regeneration Hormone

Spontaneous regression of hepatocellular carcinoma: A mini-review

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World Journal of Gastroenterology 2017年第21期23卷 3797-3804页

作者： Akira Sakamaki kenya kamimura Satoshi Abe Atsunori Tsuchiya Masaaki Takamura Hirokazu Kawai Satoshi Yamagiwa Shuji Terai Division of Gastroenterology and Hepatology Graduate School of Medical and Dental Sciences Niigata University

Spontaneous tumor regression is an extremely rare phenomenon in the oncology field. However, there are several case reports resulted in the regression of hepatocellular carcinoma(HCC) and the accumulation of clinical information and analyses of the mechanism can contribute to the development of a novel therapy. For this purpose, we have carefully reviewed 23 cases of spontaneously regressed HCC published in recent 5 years and our case. The information regarding the tumor size, tumor marker, treatments, etc., have been summarized. The mechanism of spontaneous regression has been discussed to date and presumed to be due to many factors, including hypoxia and immunological reactions. In this careful review of the 24 cases based on the clinical information, hypoxia, systemic inflammation, and both upon spontaneous regression were seen in 3, 8, and 4 cases, respectively amo ng t he 15 c as e s f or w hic h t he inf o r mat io n regarding the proposed mechanisms are available. Recent development of immunotherapeutic approaches in oncology shows promising results, therefore, accumulation of additional cases and analysis of mechanisms underlying the spontaneous regression of HCC are essential and could lead to the development of a new generation of immunotherapies including antibodies directed against immune reactions.

关键词： Spontaneous regression Hepatocellular carcinoma Immunological reaction Immunotherapy Hypoxia

Cytapheresis for pyoderma gangrenosum associated with inflammatory bowel disease:A review of current status

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World Journal of Clinical Cases 2020年第11期8卷 2092-2101页

作者： Kentaro Tominaga kenya kamimura Hiroki Sato Masayoshi Ko Yuzo Kawata Takeshi Mizusawa Junji Yokoyama Shuji Terai Division of Gastroenterology and Hepatology Graduate School of Medical and Dental SciencesNiigata UniversityNiigata 951-8510Japan

Pyoderma gangrenosum(PG)is a neutrophilic dermatosis clinically characterized by the presence of painful skin ulcerations with *** it is frequently associated with inflammatory bowel diseases,including ulcerative colitis,gastroenterologists should be familiar with the disease including therapeutic ***,we have conducted a review focusing on the cytapheresis for PG in cases of inflammatory bowel diseases.A literature search was conducted to extract studies published in the last 20 years,with information on demographics,clinical symptoms,treatment,and the clinical course from a total of 22 cases reported and our recent *** most patients,cytapheresis was associated with improvement or resolution of PG after failure of conventional therapeutic options such as corticosteroids,antibiotics,immunosuppressive agents and *** on the information summarized,cytapheresis is helpful in the majority of patients with PG refractory to medical treatment associated with inflammatory bowel diseases and could be further studied in a multicenter,randomized trial.

关键词： Granulocytapheresis Leucocytapheresis Cytapheresis Inflammatory bowel diseases Pyoderma gangrenosum Complications

Effect of Helicobacter pylori eradication on elder cases:Observational study in community-based medicine

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World Journal of Clinical Cases 2017年第12期5卷 412-418页

作者： Masaki Maruyama kenya kamimura Ayako Hoshiyama Koki Hoshiyama Mari Hoshiyama Yoshihiro Hoshiyama Shuji Terai Department of Gastroenterology Kashiwazaki General Hospital and Medical Center Department of Internal Medicine Kashiwazaki Chuo Hospital Division of Gastroenterology and Hepatology Graduate School of Medical and Dental SciencesNiigata University Department of Surgery Kashiwazaki Chuo Hospital

AIM To examine the effect of Helicobacter pylori(***)eradication therapy on the extra-gastrointestinal factors in elderly patients by a before-after observational study in community *** records(1 May 2013-31 January 2014)of 130patients who underwent *** eradication therapy with 2-year after-eradication observation in our institute were *** on sex;age;body weight;body mass index(BMI);mean corpuscular volume(MCV);total protein;low-density lipoprotein cholesterol,triglyceride,haemoglobin A1c and haemoglobin levels and gastric hyperplastic polyps(GHPs)at eradication was ***-year after-eradication change in data was analysed by paired-sample t-test;relationship between GHPs and subclinical iron deficiency anaemia(IDA)improvement was *** mean patient age(median,interquartile range)at eradication was 69.6(71.5,64-77)***-sample t-tests showed that body weight,BMI and MCV increased by 0.52 kg(P=0.018),0.25 kg/m^2(P=0.006)and 0.83f L(P<0.001),*** nonparametric MannWhitney test showed no significant difference in the change rate of MCV after eradication between the groups with and without GHPs(P=0.892).*** eradication therapy prevented weight loss and subclinical IDA in elderly *** were not associated with subclinical IDA.

关键词： Helicobacter pylori Iron deficiency anaemia Body weight Elderly Polyp