研究者詳細 - 髙原　政宏

論文 - 髙原　政宏

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Acetic Acid-Indigo Carmine Chromocolonoscopy for Proximal Serrated Lesions: A Randomized, Three-Arm Colonoscopy Study. 国際誌

Hideaki Kinugasa, Sakiko Hiraoka, Sayo Kobayashi, Minoru Matsubara, Teruya Nagahara, Reiji Higashi, Kensuke Takei, Masayasu Ohmori, Takashi Nakamura, Takao Tsuzuki, Shouichi Tanaka, Ryosuke Hirai, Junki Toyosawa, Yuki Aoyama, Yasushi Yamasaki, Toshihiro Inokuchi, Masahiro Takahara, Takehiro Tanaka, Toshiharu Mitsuhashi, Motoyuki Otsuka

The American journal of gastroenterology 2025年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: Aggressive colorectal cancer (CRC) frequently originates from serrated lesions (SLs), particularly in the proximal colon, which are challenging to detect using standard screening colonoscopy. Although duplicate examinations or chromocolonoscopies are recommended for detecting proximal SLs, evidence from randomized trials is limited. We evaluated the effectiveness of tandem colonoscopy with an acetic acid-indigo carmine mixture (AIM) for detecting SLs in the proximal colon compared to white-light imaging (WLI) and indigo carmine (IC). METHODS: This three-arm, multicenter, randomized controlled trial involving nine institutions enrolled patients undergoing colonoscopy and assigned them randomly to the WLI, IC, or AIM group. The primary outcomes were the SL-detection rate (SDR) of proximal lesions during the second examination (SDR2nd) and SL additional rate (SAR). Secondary outcomes included the detection and additional rates of other polyps, factors contributing to SAR, and complications. RESULTS: Between 2021 and 2024, 1,319 participants with 1,267 polyps were included in the analysis. With AIM, the SDR2nd and SAR were significantly higher compared to WLI or IC (WLI vs. AIM: 2.7% vs. 14.0%, p<.001; IC vs. AIM: 7.9% vs. 14.0%, p=.002, and WLI vs. AIM: 22.4% vs. 69.3%, p<.001; IC vs. AIM: 45.8% vs. 69.3%, p=.001). AIM conferred a higher adenoma-detection rate (ADR)2nd than with WLI (10.5% vs. 24.7%; p<.001) and was an independent factor for SAR (odds ratio [95% confidence interval]: 7.79 [3.76-17.08]). No major adverse events were observed. CONCLUSIONS: AIM significantly improved proximal colon SDRs and outperformed WLI and IC. The relationship between SDR and CRC incidence warrants further investigation.

DOI： 10.14309/ajg.0000000000003411

Changes of leucine-rich alpha 2 glycoprotein could be a marker of changes of endoscopic and histologic activity of ulcerative colitis. 国際誌

Yuki Aoyama, Sakiko Hiraoka, Eriko Yasutomi, Toshihiro Inokuchi, Takehiro Tanaka, Kensuke Takei, Shoko Igawa, Keiko Takeuchi, Masahiro Takahara, Junki Toyosawa, Yasushi Yamasaki, Hideaki Kinugasa, Jun Kato, Hiroyuki Okada, Motoyuki Otsuka

Scientific reports 15 ( 1 ) 5248 - 5248 2025年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

Leucine-rich alpha 2 glycoprotein (LRG) is one of the serum biomarkers for disease activity of ulcerative colitis (UC). We focused on the correlation between the changes of LRG and the changes of endoscopic and histologic activity of UC, in comparison to the changes of fecal calprotectin (Fcal), fecal immunochemical test (FIT), and C-reactive protein (CRP). Seventy-nine patients with two or more colonoscopies were enrolled, and 123 paired colonoscopies and 121 paired biopsies were examined. With regard to the change of endoscopic/histologic activity between the preceding and subsequent colonoscopy, there was improvement (n = 29/45), unchanging (n = 63/36), and worsening (n = 31/40). The correlations between the changes of marker levels and endoscopic/histologic activity were Fcal; r = 0.50/0.39 and FIT; r = 0.41/0.40, LRG; r = 0.42/0.40 and CRP; r = 0.22/0.17. Furthermore, when the correlation between the changes of LRG levels and the changes of endoscopic/histological activity was compared with those of other markers, the correlation of LRG tended to be superior to those of CRP (CRP vs. LRG; p = 0.08/0.01). LRG is equivalent to fecal markers and superior to CRP, when inferring changes in disease activity of UC based on changes in its level.

DOI： 10.1038/s41598-025-89615-8

Short- and longer-term learning effects from virtual scale endoscopy videos: a useful tool for colorectal lesion size estimation (with video). 国際誌

Ryosuke Hirai, Hideaki Kinugasa, Mikako Ishiguro, Junki Toyosawa, Yuki Aoyama, Shoko Igawa, Yasushi Yamasaki, Toshihiro Inokuchi, Masahiro Takahara, Seiji Kawano, Sakiko Hiraoka, Motoyuki Otsuka

Gastrointestinal endoscopy 2024年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIMS: Accurate assessment of colorectal polyp size is crucial for determining treatment and surveillance policies. However, visual estimation of lesion diameter is often inaccurate, making simple and effective educational tools essential. We aimed to evaluate the learning effects of virtual scale endoscopy (VSE). METHODS: Thirty-three endoscopists first watched pre-learning videos for SET1. They then estimated the diameters of 20 lesions and referred to instructional videos with VSE for self-study. Subsequently, they watched the post-learning videos for SET2 and estimated the lesion diameters. The error between the estimated and correct lesion sizes of both sets was compared. To evaluate longer-term learning effects, participants answered SET3 and SET4, which consisted of the same questions as SET2 and SET1, respectively, 2-3 months later without watching the instructional video for SET2. RESULTS: The error in the participants' estimation of the correct lesion diameter improved from SET1 to SET2 (34.7 mm ± 6.6 vs. 30.7 mm ± 7.7; p = 0.048), with a significant learning effect and error improvement specifically among non-experts (35.2 mm ± 5.3 vs. 30 mm ± 6.8; p = 0.028). In the SET3 and SET4, participants' errors indicated that the learning effect was well maintained (SET2 vs. SET3; 30.7 mm ± 7.7 vs. 28.6 mm ± 7.2; p = 0.1, and SET1 and SET4: 34.7 mm ± 6.6 vs. 31.7 mm ± 7.1; p = 0.025). CONCLUSIONS: VSE videos are a valuable learning tool for estimating lesion diameter, particularly for novice endoscopists, both in the short- and longer-term.

DOI： 10.1016/j.gie.2024.10.038

増大号炎症性腸疾患2024 主題炎症性腸疾患の内科治療基本治療薬(5-ASA製剤,副腎皮質ステロイド,チオプリン製剤)

平岡佐規子, 石黒美佳子, 豊澤惇希, 青山祐樹, 井川翔子, 竹内桂子, 山崎泰史, 井口俊博, 衣笠秀明, 髙原政宏, 大塚基之, 金谷信彦, 近藤喜太, 田中健大

胃と腸 59 ( 10 ) 1453 - 1461 2024年10月

Adverse events after different endoscopic resection procedures for small and intermediate-sized colorectal polyps. 査読国際誌

Junki Toyosawa, Yasushi Yamasaki, Yuki Aoyama, Kensuke Takei, Shoko Igawa, Toshihiro Inokuchi, Hideaki Kinugasa, Masahiro Takahara, Sakiko Hiraoka, Hiroyuki Okada, Motoyuki Otsuka

Digestive diseases (Basel, Switzerland) 1 - 9 2024年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND STUDY AIMS: Cold snare polypectomy (CSP) and underwater endoscopic mucosal resection (UEMR) have been developed recently, in addition to conventional methods, but adverse events of each method have not been fully clarified. We compared outcomes of each method for the appropriate choice. PATIENTS AND METHODS: Patients who underwent CSP, endoscopic mucosal resection (EMR)/hot snare polypectomy (HSP) or UEMR for small and intermediate-sized colorectal polyps between April 2017 and June 2020 were retrospectively examined. The rate of adverse events and recurrences due to each method were determined as main outcomes. Clinical factors related with adverse events were examined. RESULTS: A total of 1,025 patients with 3,163 polyps underwent polypectomy using any of the methods. CSP, EMR/HSP and UEMR were performed for 704 (22.2%), 2,145 (67.8%) and 314 polyps (9.9%), and median size for each method was 4, 6 and 7 mm, respectively. Delayed bleeding for CSP, EMR/HSP and UEMR was 0%, 0.2% and 0.6% (P = 0.15), and perforation was 0%, 0.1% and 0%, respectively (P = 0.62). Recurrence after CSP, EMR/HSP and UEMR was 0.1%, 0.04% and 1.0%, respectively (P < 0.01). Recurrence for UEMR was significantly higher in the early stage of procedure introduction (P = 0.001). Oral anticoagulants were the risk factor for delayed bleeding (P < 0.01, respectively). CONCLUSIONS: There was no significant difference regarding adverse events among each method for small and intermediate-sized polyps, although recurrence rate after UEMR was higher than other methods.

DOI： 10.1159/000540365

Efficacy and safety of filgotinib for ulcerative colitis: A real-world multicenter retrospective study in Japan. 査読国際誌

Shintaro Akiyama, Kaoru Yokoyama, Soichi Yagi, Shinichiro Shinzaki, Kozo Tsuruta, Shinichiro Yoshioka, Minako Sako, Hiromichi Shimizu, Mariko Kobayashi, Toshiyuki Sakurai, Kei Nomura, Tomoyoshi Shibuya, Masahiro Takahara, Sakiko Hiraoka, Kyohei Sugai, Shunichi Yanai, Atsushi Yoshida, Miki Koroku, Teppei Omori, Masayuki Saruta, Takayuki Matsumoto, Ryuichi Okamoto, Kiichiro Tsuchiya, Toshimitsu Fujii

Alimentary pharmacology & therapeutics 59 ( 11 ) 1413 - 1424 2024年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIMS: While filgotinib, an oral Janus kinase (JAK) 1 preferential inhibitor, is approved for moderately to severely active ulcerative colitis (UC), real-world studies assessing its short- and long-term efficacy and safety are limited. METHODS: This is a multicenter, retrospective study of UC patients who started filgotinib between March 2022 and September 2023. The primary outcome was clinical remission, defined as a partial Mayo score ≤1 with a rectal bleeding score of 0, or Simple Clinical Colitis Activity Index (SCCAI) ≤2 with a blood-in-stool score of 0. Secondary outcomes included clinical response, corticosteroid-free remission, and endoscopic improvement. Outcomes were assessed at 10, 26, and 58 weeks based on patients with available follow-up. Adverse events were evaluated. RESULTS: We identified 238 UC patients and 54% had prior exposure to biologics/JAK inhibitors. The median baseline partial Mayo score and SCCAI were 5 (IQR 3-6) and 4 (IQR 2-7). Clinical remission rates based on per-protocol analysis at 10, 26, and 58 weeks were 47% (70/149), 55.8% (48/86), and 64.6% (31/48), respectively. At a median follow-up of 28 weeks (IQR 10-54) with a discontinuation rate of 39%, the rates of clinical remission, clinical response, corticosteroid-free remission, and endoscopic improvement were 39.9% (81/203), 54.7% (111/203), and 36.5% (74/203), and 43.5% (10/23), respectively. These rates were comparable between biologic/JAK inhibitor-naïve and -experienced patients. While three patients (1.3%) developed herpes zoster infection, no cases of thrombosis or death were reported. CONCLUSIONS: Real-world data demonstrate favourable clinical and safety outcomes of filgotinib for UC.

DOI： 10.1111/apt.17961

消化管の炎症を診るクローン病小腸病変評価における経腹超音波検査の有用性

高原政宏, 平岡佐規子, 青山祐樹, 井川翔子, 井口俊博, 大西秀樹, 大塚基之

超音波医学 51 ( Suppl. ) S187 - S187 2024年4月

UnderwaterとUnder-gelでの大腸腫瘍性病変に対する境界診断能の検討

豊澤惇希, 山崎泰史, 青山祐樹, 井川翔子, 井口俊博, 衣笠秀明, 高原政宏, 平岡佐規子, 大塚基之

Gastroenterological Endoscopy 66 ( Suppl.1 ) 969 - 969 2024年4月

Utility of Combined Use of Transabdominal Ultrasonography and Fecal Immunochemical Test Examinations in Ulcerative Colitis. 査読

Masahiro Takahara, Sakiko Hiraoka, Masayasu Ohmori, Keiko Takeuchi, Kensuke Takei, Yuki Aoyama, Eriko Yasutomi, Shoko Igawa, Toshihiro Inokuchi, Junki Toyosawa, Yasushi Yamasaki, Hideaki Kinugasa, Keita Harada, Hideki Onishi, Hiroyuki Okada

Acta medica Okayama 78 ( 1 ) 79 - 83 2024年2月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）

This study examined the utility of the combined use of transabdominal ultrasonography (TUS) and fecal immunochemical testing (FIT) to detect mucosal inflammation, vis-a-vis the Mayo endoscopic subscore (MES), in ulcerative colitis (UC). Sixty-three UC patients who underwent TUS and FIT were retrospectively enrolled. For TUS, the colon was divided into five segments, and the bowel wall thickness was measured and evaluated. The accuracy of FIT (> 100 ng/ml) in detecting mucosal inflammation (MES>0) was 0.93, whereas that of TUS (BWT>2 mm) in each segment was 0.84-0.97. The combined use of TUS and FIT may be helpful in noninvasive treatment strategies.

DOI： 10.18926/AMO/66674

Anti-PD-1 Autoantibody Predicts Survival of Patients With Hepatocellular Carcinoma Receiving Atezolizumab/Bevacizumab

Yuki Sasaki, Kazuyuki Matsumoto, Akinobu Takaki, Takuya Adachi, Masahiro Takahara, Keita Ozato, Yasuto Takeuchi, Masahiko Sue, Nozomi Miyake, Nozomu Wada, Hideki Onishi, Hidenori Shiraha, Takashi Oda, Koichiro Tsutsumi, Kazuhiro Nouso, Kazuya Kariyama, Hiroaki Hagihara, Akio Moriya, Motoyuki Otsuka

Gastro Hep Advances 3 ( 8 ) 1138 - 1147 2024年1月

掲載種別：研究論文（学術雑誌）

Background and Aims: Methods for predicting therapeutic response to immune checkpoint inhibitors in cancer therapy are in high demand. In patients with advanced hepatocellular carcinoma (HCC), atezolizumab (anti-programmed cell death-ligand 1 [PD-L1]) and bevacizumab (anti-vascular endothelial growth factor) combination therapy (Atezo/Bev therapy) is a first-line treatment. However, no reliable biomarkers are currently available to predict its efficacy. Here, we examined serum anti-PD-1 autoantibody levels as candidate biomarkers. Methods: We prospectively enrolled 63 patients with advanced HCC who received Atezo/Bev therapy. Serum anti-PD-1 autoantibody levels were measured before treatment using an indirect enzyme-linked immunosorbent assay. The correlation between the titers and response to therapy was statistically examined. Results: Serum anti-PD-1 autoantibody levels were not significantly associated with the treatment response in any patient. However, when examining only patients who received the Atezo/Bev as their first-line therapy, higher anti-PD-1 autoantibody levels were significantly associated with worse overall survival rates. The titer was an independent risk factor for poor prognosis (odds ratio [OR] = 7.8, P = .013), in addition to a higher neutrophil-to-lymphocyte ratio (OR = 7.1, P = .009) and lower albumin levels (OR = 14.2, P = .003). Conclusion: Serum anti-PD-1 autoantibody levels correlated with the overall survival rate in patients who received Atezo/Bev as first-line therapy. Serum anti-PD-1 autoantibody levels may serve as new biomarkers for predicting the efficacy of immune checkpoint inhibitors in patients with HCC.

DOI： 10.1016/j.gastha.2024.07.018

大腸神経節細胞腫により診断に至ったCowden症候群の1例

本田真奈美, 山崎泰史, 豊澤惇希, 井口俊博, 衣笠秀明, 高原政宏, 田中健大, 平岡佐規子, 大塚基之

日本消化器病学会中国支部例会・日本消化器内視鏡学会中国支部例会プログラム・抄録集 120回・131回 68 - 68 2023年11月

Low Patient Weight and Long Intubation Time Are Key Factors for Pain during Colonoscopy. 査読

Shohei Oka, Keita Harada, Shumpei Yamamoto, Eriko Yasutomi, Shoko Igawa, Masayasu Ohmori, Mami Hirai, Yasushi Yamasaki, Toshihiro Inokuchi, Hideaki Kinugasa, Masahiro Takahara, Sakiko Hiraoka, Hiroyuki Okada

Acta medica Okayama 77 ( 5 ) 471 - 478 2023年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

Although the clinical usefulness of colonoscopy has been established, the procedure remains painful for many patients. This study was designed to clarify the factors predicting colonoscopy-related pain. We evaluated 283 consecutive patients who completed a first-ever, total colonoscopy without sedatives or analgesics. The severity of pain symptoms was evaluated by a numeric rating scale (NRS) in a questionnaire immediately after the colonoscopy. Patient backgrounds and endoscopic findings were analyzed to evaluate their association with pain. Out of 283 patients, 53 scored their pain 0-1 on the NRS while 48 scored it 6-10. We defined the colonoscopies of the former and latter patients as painless and painful, respectively, and compared the two. Multivariate analyses revealed that low body weight (OR 4.95, 95%CI 1.89-12.99) and longer intubation time (OR 3.63, 95%CI 1.46-9.03) were significant risk factors for painful colonoscopy. To identify factors contributing to the increased intubation time, we divided subjects into short- and long-intubation-time groups based on a median insertion time of 7 min. Older age (OR 2.28, 95%CI 1.31-3.98), previous abdominal surgery (OR 1.93, 95%CI 1.13-3.32) and findings of invasive cancer (OR 10.90, 95%CI 1.34-88.90) were significant factors for longer intubation time.

DOI： 10.18926/AMO/65969

IBD診療におけるtreat to targetを考える Treat to targetを意識したクローン病におけるsurrogate markerの組み合わせ

井口俊博, 平岡佐規子, 青山祐樹, 竹井健介, 井川翔子, 高原政宏, 大塚基之

日本大腸肛門病学会雑誌 76 ( 9 ) A51 - A51 2023年9月

IBD診療におけるtreat to targetを考える Treat to targetを意識したクローン病におけるsurrogate markerの組み合わせ

井口俊博, 平岡佐規子, 青山祐樹, 竹井健介, 井川翔子, 高原政宏, 大塚基之

日本大腸肛門病学会雑誌 76 ( 9 ) A51 - A51 2023年9月

血流豊富な粘膜下腫瘍の形態を呈した上行結腸血管周囲類上皮細胞腫の1例

青山祐樹, 井口俊博, 平岡佐規子, 豊澤惇希, 竹井健介, 井川翔子, 山崎泰史, 衣笠秀明, 高原政宏, 庄司良平, 近藤喜太, 柳井広之, 大塚基之

日本消化器内視鏡学会中国支部例会 130回 81 - 81 2023年6月

膵癌化学療法における血中自己抗体を用いた治療効果予測の可能性

松本和幸, 高木章乃夫, 高原政宏, 小幡泰介, 藤井佑樹, 山崎辰洋, 内田大輔, 堀口繁, 堤康一郎, 加藤博也

日本消化器病学会雑誌 120 ( 臨増総会 ) A292 - A292 2023年3月

【あなたの知らないIBD診療の世界】新規治療法・検査法 IBDに対するバイオマーカーの使い方血中マーカーと便中マーカー

井口俊博, 平岡佐規子, 青山祐樹, 竹井健介, 井川翔子, 高原政宏

臨床消化器内科 38 ( 4 ) 422 - 428 2023年3月

記述言語：日本語出版者・発行元：(株)日本メディカルセンター

＜文献概要＞潰瘍性大腸炎およびクローン病を含む炎症性腸疾患(IBD)は,単なる症状の改善にとどまらず,内視鏡的な治癒を目指すことにより予後が改善することが証明されている.したがって内視鏡的活動性の把握が重要であり,内視鏡重症度の代替マーカーである,血中,便中マーカーをそれぞれ上手に使いこなすことが肝要である.一方で各マーカーの注意点があり,血中マーカーではCRPだけでなく,近年LRGが利用可能となり,実臨床での活用が期待される.また便中マーカーはとくに疾患活動性が落ちてきたステージでの利用がより有用であり,内視鏡的寛解の判断に強みをもつ.IBD診療においては,各マーカーの長所,注意点に習熟し,より良いモニタリングを行うことが求められる.

【IBDの既存治療を最新の知見から見直す!】IBDの5-ASA製剤による治療を見直す

高原政宏, 平岡佐規子, 井口俊博

IBD Research 16 ( 4 ) 219 - 224 2022年12月

記述言語：日本語出版者・発行元：(株)先端医学社

5-アミノサリチル酸(5-ASA)製剤は,安全性が高く,使用しやすい薬剤であり,炎症性腸疾患(IBD),とくに潰瘍性大腸炎においては,軽症～中等症の治療薬の第一選択薬として,寛解導入から寛解維持まで広く用いられている.わが国では,現在使用できる5-ASA製剤は4種類あり,各薬剤の特徴を理解したうえで,病勢や患者の状況に合わせて薬剤の選択をしていく.IBD患者の増加に伴い,5-ASA製剤の使用頻度は今後,さらに増していくであろう一方で,近年は5-ASA製剤の不耐症例も増加している.不耐の特徴や対処法に関する知識も必要とされ,適切な対応を取ることも求められている.(著者抄録)

【高齢者潰瘍性大腸炎の現状】高齢者潰瘍性大腸炎の内科的治療とその見極め

井口俊博, 高原政宏, 平岡佐規子

日本消化器病学会雑誌 119 ( 11 ) 992 - 1003 2022年11月

記述言語：日本語出版者・発行元：(一財)日本消化器病学会

近年,高齢潰瘍性大腸炎(UC)患者数が増加しており,特に若年発症して長期経過を追っている高齢UC症例と異なり,高齢になって新規に発症したUCは治療に難渋する症例が少なくない.また年齢だけで高齢者の全身状態を判断することはできず,症例によって脆弱性やリスクが異なるため,注意が必要である.現在使用できる治療薬はいずれも高齢者を対象とした試験を経ず保険収載されており,リアルワールドデータを基に有効性,安全性の判断をせざるを得ない.高齢者特有の併存疾患の管理,ポリファーマシーと相互作用,認知症,身体機能低下,易感染状態などのリスクを考慮し,重篤な状態になる前に常に早期介入を心掛ける必要がある.(著者抄録)

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J01118&link_issn=&doc_id=20221116250003&doc_link_id=10.11405%2Fnisshoshi.119.992&url=https%3A%2F%2Fdoi.org%2F10.11405%2Fnisshoshi.119.992&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

【高齢者潰瘍性大腸炎の現状】高齢者潰瘍性大腸炎の内科的治療とその見極め

井口俊博, 高原政宏, 平岡佐規子

日本消化器病学会雑誌 119 ( 11 ) 992 - 1003 2022年11月

記述言語：日本語出版者・発行元：(一財)日本消化器病学会

近年,高齢潰瘍性大腸炎(UC)患者数が増加しており,特に若年発症して長期経過を追っている高齢UC症例と異なり,高齢になって新規に発症したUCは治療に難渋する症例が少なくない.また年齢だけで高齢者の全身状態を判断することはできず,症例によって脆弱性やリスクが異なるため,注意が必要である.現在使用できる治療薬はいずれも高齢者を対象とした試験を経ず保険収載されており,リアルワールドデータを基に有効性,安全性の判断をせざるを得ない.高齢者特有の併存疾患の管理,ポリファーマシーと相互作用,認知症,身体機能低下,易感染状態などのリスクを考慮し,重篤な状態になる前に常に早期介入を心掛ける必要がある.(著者抄録)

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01118&link_issn=&doc_id=20221116250003&doc_link_id=%2Fck8syokb%2F2022%2F011911%2F003%2F0992-1003%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fck8syokb%2F2022%2F011911%2F003%2F0992-1003%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

【潰瘍性大腸炎内科診療の新時代】日常診療に有用な潰瘍性大腸炎のバイオマーカー

青山祐樹, 平岡佐規子, 井口俊博, 竹井健介, 井川翔子, 竹内桂子, 高原政宏

医学と薬学 79 ( 11 ) 1461 - 1468 2022年10月

クローン病患者の内視鏡活動性と活動性の変化を予測するバイオマーカーは?

井口俊博, 平岡佐規子, 豊澤惇希, 竹井健介, 青山祐樹, 井川翔子, 竹内桂子, 山崎泰史, 衣笠秀明, 高原政宏, 原田馨太, 岡田裕之

日本消化器病学会雑誌 119 ( 臨増大会 ) A750 - A750 2022年10月

生検検体を用いた胆道癌におけるPD-L1発現の検討

松本和幸, 高木章乃夫, 大原利章, 藤澤真義, 高原政宏, 加藤博也, 吉田龍一, 楳田祐三, 八木孝仁, 松川昭博

日本消化器病学会雑誌 119 ( 臨増大会 ) A730 - A730 2022年10月

生検検体を用いた胆道癌におけるPD-L1発現の検討

松本和幸, 高木章乃夫, 大原利章, 藤澤真義, 高原政宏, 加藤博也, 吉田龍一, 楳田祐三, 八木孝仁, 松川昭博

日本消化器病学会雑誌 119 ( 臨増大会 ) A730 - A730 2022年10月

クローン病患者の内視鏡活動性と活動性の変化を予測するバイオマーカーは?

井口俊博, 平岡佐規子, 豊澤惇希, 竹井健介, 青山祐樹, 井川翔子, 竹内桂子, 山崎泰史, 衣笠秀明, 高原政宏, 原田馨太, 岡田裕之

日本消化器病学会雑誌 119 ( 臨増大会 ) A750 - A750 2022年10月

The Colon Wall Thickness Measured Using Transabdominal Ultrasonography Is Useful for Detecting Mucosal Inflammation in Ulcerative Colitis. 査読

Masahiro Takahara, Sakiko Hiraoka, Masayasu Ohmori, Keiko Takeuchi, Kensuke Takei, Eriko Yasutomi, Shoko Igawa, Shumpei Yamamoto, Yasushi Yamasaki, Toshihiro Inokuchi, Hideaki Kinugasa, Keita Harada, Hideki Ohnishi, Hiroyuki Okada

Internal medicine (Tokyo, Japan) 61 ( 18 ) 2703 - 2709 2022年9月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）

Objective Transabdominal ultrasonography (TUS) is a non-invasive procedure that is reportedly useful for managing ulcerative colitis (UC) and assessing bowel wall thickness (BWT), the most common measure of mucosal inflammation. However, the exact range of BWT that reflects disease activity remains undetermined. The present study clarified the BWT due to disease activity by comparing the use of TUS in each segment of the colon versus using colonoscopy (CS) and determined the usefulness of TUS in patients with UC. Methods We divided the colon into five segments and measured the BWT using TUS. The results were then compared to the Mayo endoscopic subscore (MES) classification to determine the accuracy of BWT measurement. Patients Eighty patients with UC who underwent TUS within 14 days of CS were retrospectively registered. Results We evaluated a total of 268 images depicting each segment among 80 patients with UC. The BWT was positively correlated with endoscopic activity (0.69, p<0.0001). In each segment, the relationship between a BWT>2 mm and an MES>0 had the highest sensitivity, specificity, and accuracy (0.85-1.00, 0.67-0.92, and 0.81-0.97, respectively). Conclusion This study concluded that TUS was a useful method of detecting an MES>0, which indicates the presence of inflammation and its location among UC patients. MES>0 was found to be highly accurate when a BWT>2 mm was considered positive. This non-invasive method may help control disease activity in patients with UC.

DOI： 10.2169/internalmedicine.8827-21

消化管疾患と性差女性IBD患者における月経周期と腹部症状との関わりを探る

井口俊博, 平岡佐規子, 青山祐樹, 竹井健介, 井川翔子, 竹内桂子, 高原政宏, 近藤喜太

日本高齢消化器病学会誌 25 ( 1 ) 144 - 144 2022年7月

Usefulness of Intestinal Ultrasound to Detect Small Intestinal Stenosis in Patients with Crohn's Disease. 査読国際誌

Keiko Takeuchi, Toshihiro Inokuchi, Masahiro Takahara, Masayasu Ohmori, Eriko Yasutomi, Shohei Oka, Shoko Igawa, Kensuke Takei, Yuki Baba, Seiji Kawano, Yasushi Yamasaki, Hideaki Kinugasa, Keita Harada, Sakiko Hiraoka, Hiroyuki Okada

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 42 ( 2 ) 373 - 383 2022年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: Double balloon enteroscopy (DBE) with retrograde contrast is useful as a monitoring tool for small intestinal lesions in Crohn's disease (CD), but these are burdensome for patients. Intestinal ultrasound (IUS) can be used with ease in daily clinical practice, but there is less evidence regarding the accuracy of detection of small intestinal stenosis in CD. This study aimed to examine the diagnostic power of IUS for small intestinal stenosis in patients with CD. METHODS: The findings of DBE and IUS in 86 patients with CD with small intestinal lesions were evaluated. Using DBE as the reference standard, we examined the detection rate of IUS for small intestinal stenosis. We evaluated three parameters: luminal narrowing, prestenotic dilation, and to-and-fro movement for determining stenosis using IUS. In addition, we compared the characteristics between the stenosis-detectable and stenosis-undetectable groups by IUS. RESULTS: Of the 86 patients, 30 had small intestinal stenosis. In IUS findings, when lesions that met two or more of the three parameters were judged as stenosis, the detection rate was 70.0% for sensitivity, 98.2% for specificity, and 88.4% for accuracy. Moreover, there were patients with a younger age at diagnosis (P < 0.05) and more ileocolonic disease location (P < 0.05) in the stenosis-detectable group by IUS. The stenoses detected by IUS were significantly longer than those undetected by IUS (14.1 mm versus 5.2 mm, P < 0.05). CONCLUSIONS: IUS delivered reliable results for clinically important small intestinal stenosis of CD with high diagnostic accuracy.

DOI： 10.1002/jum.16038

人工肛門造設状態で帝王切開による分娩が可能であった難治性クローン病の一例

安富有希, 井川翔子, 青山祐樹, 竹井健介, 安富絵里子, 井口俊博, 高原政宏, 平岡佐規子, 岡田裕之, 近藤喜太

日本消化器病学会中国支部例会プログラム・抄録集 117回 69 - 69 2022年6月

消化管の炎症性疾患における超音波の役割クローン病の活動性評価における経腹超音波検査の有用性

高原政宏, 平岡佐規子, 大森正泰, 竹内佳子, 井口俊博, 大西秀樹, 岡田裕之

超音波医学 49 ( Suppl. ) S243 - S243 2022年4月

UnderwaterとUnder-gelでの大腸腫瘍性病変に対する境界診断能の検討

豊澤惇希, 山崎泰史, 岡田裕之, 竹井健介, 青山祐樹, 井川翔子, 安富絵里子, 山本峻平, 竹内桂子, 高原政宏, 衣笠秀明, 原田馨太, 平岡佐規子

Gastroenterological Endoscopy 64 ( Suppl.1 ) 761 - 761 2022年4月

Diagnostic Utility of the PD-L1 Immunostaining in Biopsy Specimens of Patients with Biliary Tract Neoplasms. 査読国際誌

Kazuyuki Matsumoto, Toshiaki Ohara, Masayoshi Fujisawa, Akinobu Takaki, Masahiro Takahara, Hironari Kato, Ryuichi Yoshida, Yuzo Umeda, Takahito Yagi, Akihiro Matsukawa, Hiroyuki Okada

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 26 ( 6 ) 1213 - 1223 2022年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Anti-programmed death 1/programmed death ligand 1 (PD1/PD-L1) antibodies have been successfully used as treatment agents for several solid tumors; however, it is difficult to predict their effectiveness. We evaluated whether biopsy specimens could predict the positive status of PD-L1 in surgically resected tissue. METHODS: Among 91 patients who underwent tissue sampling with endoscopic or liver biopsy before surgery for biliary tract neoplasms in an academic center, 45 (49%) patients were selected for retrospective analysis because the quality and quantity of their biopsy specimens were adequate for histologic evaluation. We performed immunohistochemical staining to investigate the PD-L1 expression in both resected and biopsy specimens. The percentage of the positively stained cells was calculated for subsequent use in the correlation investigation. RESULTS: The biopsy methods were endoscopic retrograde cholangiopancreatography (ERCP) in 28 cases, percutaneous liver biopsy in 10 cases, and endoscopic ultrasound fine-needle aspiration in 7 cases. Among the 45 patients, when patients with > 10% positive tumor cells in surgically resected tissues were regarded as truly positive PD-L1, the positive and negative concordance rates between surgically resected tissues and biopsy samples were 56% (5/9) and 100% (36/36), respectively. With regard to the use of preoperative biopsy as a diagnostic tool, all (5/5) PD-L1-positive patients had a positive resected specimen. The accuracy of each biopsy method was as follows: ERCP, 89% (25/28); fine-needle aspiration, 86% (6/7); and liver biopsy, 100% (10/10). CONCLUSIONS: Biopsy samples could be a surrogate material for the assessment of the PD-L1 expression with substantial positive and high negative concordance rates.

DOI： 10.1007/s11605-021-05197-6

Metformin ameliorates chronic colitis in a mouse model by regulating interferon-γ-producing lamina propria CD4+ T cells through AMPK activation. 査読国際誌

Masahiro Takahara, Akinobu Takaki, Sakiko Hiraoka, Kensuke Takei, Eriko Yasutomi, Shoko Igawa, Shumpei Yamamoto, Shohei Oka, Masayasu Ohmori, Yasushi Yamasaki, Toshihiro Inokuchi, Hideaki Kinugasa, Keita Harada, Heiichiro Udono, Hiroyuki Okada

FASEB journal : official publication of the Federation of American Societies for Experimental Biology 36 ( 2 ) e22139 2022年2月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）

Metformin, a commonly prescribed drug for type 2 diabetes mellitus, has been shown to activate AMP-activated protein kinase (AMPK). Notably, AMPK activation has recently been observed to be associated with anti-inflammatory responses. Metformin is also reported to elicit anti-inflammatory responses in CD4+ T cells, resulting in improvement in experimental chronic inflammatory diseases, such as systemic lupus erythematosus. To investigate the effect of metformin on inflammatory bowel disease (IBD), we developed a T cell-transfer model of chronic colitis in which SCID mice were injected with CD4+ CD45RBhigh T cells to induce colitis. We examined the effects of metformin via in vitro and in vivo experiments on lamina propria (LP) CD4+ T cells. We observed that metformin suppresses the frequency of interferon (IFN) -γ-producing LP CD4+ T cells in vitro, which were regulated by AMPK activation, a process possibly induced by the inhibition of oxidative phosphorylation. Furthermore, we examined the effects of metformin on an in vivo IBD model. Metformin-treated mice showed AMPK activation in LP CD4+ T cells and ameliorated colitis. Our study demonstrates that metformin-induced AMPK activation in mucosal CD4+ T cells contributes to the improvement of IBD by suppressing IFN-γ production. Moreover, our results indicate that AMPK may be a target molecule for the regulation of mucosal immunity and inflammation. Thus, AMPK-activating drugs such as metformin may be potential therapeutic agents for the treatment of IBD.

DOI： 10.1096/fj.202100831RR

[The medical treatment of elderly patients with ulcerative colitis and its limitation].

Toshihiro Inokuchi, Masahiro Takahara, Sakiko Hiraoka

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 119 ( 11 ) 992 - 1003 2022年

胆嚢良性リンパ性ポリープと胆管lymphoid hyperplasiaが併存した一例

松原弘樹, 宮本和也, 松本和幸, 神尾智宏, 原田圭, 木村彰吾, 平田翔一郎, 石田正也, 岡本雄貴, 熊原加奈, 榮浩行, 高原政宏, 竹中龍太, 藤木茂篤

日本消化器病学会中国支部例会・日本消化器内視鏡学会中国支部例会プログラム・抄録集 116回・127回 110 - 110 2021年11月

診断講座症例から学ぶIBD鑑別診断のコツ(第50回) 5-ASAアレルギー

安富絵里子, 平岡佐規子, 竹井健介, 井川翔子, 岡昌平, 井口俊博, 高原政宏, 岡田裕之

IBD Research 15 ( 2 ) 109 - 114 2021年6月

記述言語：日本語出版者・発行元：(株)先端医学社

5-アミノサリチル酸(5-ASA)製剤は軽症から中等症の潰瘍性大腸炎(UC)に対する第一選択薬で基本的には安全な薬剤である。しかしながら、5-ASA製剤の投与に伴いUCの増悪と鑑別がむずかしい下痢・血便の増悪を伴う『5-ASAアレルギー』が起こり得、さらに最近、その頻度も増加傾向にあるとされ注目されている。まず5-ASAアレルギーという病態があることを認識し、経過から5-ASAアレルギーの可能性を疑う場合、5-ASA製剤を中止する『勇気』をもつことが大事である。また、その後の経過が難治になる症例もありうるため、早めに専門医への紹介を考慮すべきである。(著者抄録)

Leucine-rich alpha-2 glycoprotein as a marker of mucosal healing in inflammatory bowel disease. 査読国際誌

Eriko Yasutomi, Toshihiro Inokuchi, Sakiko Hiraoka, Kensuke Takei, Shoko Igawa, Shumpei Yamamoto, Masayasu Ohmori, Shohei Oka, Yasushi Yamasaki, Hideaki Kinugasa, Masahiro Takahara, Keita Harada, Masaki Furukawa, Kouichi Itoshima, Ken Okada, Fumio Otsuka, Takehiro Tanaka, Toshiharu Mitsuhashi, Jun Kato, Hiroyuki Okada

Scientific reports 11 ( 1 ) 11086 - 11086 2021年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

Leucine-rich alpha-2 glycoprotein (LRG) may be a novel serum biomarker for patients with inflammatory bowel disease. The association of LRG with the endoscopic activity and predictability of mucosal healing (MH) was determined and compared with those of C-reactive protein (CRP) and fecal markers (fecal immunochemical test [FIT] and fecal calprotectin [Fcal]) in 166 ulcerative colitis (UC) and 56 Crohn's disease (CD) patients. In UC, LRG was correlated with the endoscopic activity and could predict MH, but the performance was not superior to that of fecal markers (areas under the curve [AUCs] for predicting MH: LRG: 0.61, CRP: 0.59, FIT: 0.75, and Fcal: 0.72). In CD, the performance of LRG was equivalent to that of CRP and Fcal (AUCs for predicting MH: LRG: 0.82, CRP: 0.82, FIT: 0.70, and Fcal: 0.88). LRG was able to discriminate patients with MH from those with endoscopic activity among UC and CD patients with normal CRP levels. LRG was associated with endoscopic activity and could predict MH in both UC and CD patients. It may be particularly useful in CD.

DOI： 10.1038/s41598-021-90441-x

IBD診療における超音波の有用性クローン病小腸狭窄病変に対する経腹壁超音波検査の病変検出率の検討

竹内桂子, 井口俊博, 高原政宏, 大森正泰, 竹井健介, 安富絵里子, 岡昌平, 大西秀樹, 平岡佐規子, 岡田裕之

超音波医学 48 ( Suppl. ) S309 - S309 2021年4月

Multicenter survey on mesalamine intolerance in patients with ulcerative colitis. 査読国際誌

Sakiko Hiraoka, Akiko Fujiwara, Tatsuya Toyokawa, Reiji Higashi, Yuki Moritou, Shinjiro Takagi, Kazuhiro Matsueda, Seiyuu Suzuki, Jiro Miyaike, Toshihiro Inokuchi, Masahiro Takahara, Jun Kato, Hiroyuki Okada

Journal of gastroenterology and hepatology 36 ( 1 ) 137 - 143 2021年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIM: Although oral mesalamine is the first-choice drug for treating mild-to-moderate ulcerative colitis (UC), some patients show symptoms of intolerance, including exacerbation of diarrhea and abdominal pain. The present study clarified the current state and clinical courses of patients with mesalamine intolerance. METHODS: Patients who were diagnosed with UC and administered oral mesalamine at eight hospitals in Japan with a follow-up period exceeding 1 year were analyzed. RESULTS: Sixty-seven (11%) of 633 patients showed intolerance to at least one formulation of oral mesalamine. The frequency of mesalamine intolerance has increased in recent years, rising from 5.3% in 2007-2010 to 9.1% in 2011-2013 and 16.2% in 2014-2016. The most common complications were the exacerbation of diarrhea (n = 29), a fever (n = 25), and abdominal pain (n = 22). Readministration of mesalamine/sulfasalazine was attempted in 43 patients, mostly with other types of formulation of mesalamine, and more than half of these patients proved to be tolerant. The risk factors for mesalamine intolerance were female gender (odds ratio [OR] = 1.83; 95% confidence interval [CI], 1.08-3.12), age < 60 years old (OR = 2.82; CI, 1.19-8.33), and pancolitis (OR = 2.09; 95% CI, 1.23-3.60). There were no significant differences in the use of anti-tumor necrosis factor-α agents, colectomy, or steroid-free remission at the last visit between patients with and without mesalamine intolerance. CONCLUSIONS: Mesalamine intolerance is not rare, and its frequency has been increasing recently. The prognosis of patients with mesalamine intolerance did not differ significantly from that of those without intolerance.

DOI： 10.1111/jgh.15138

Liquid biopsy for patients with IBD-associated neoplasia. 査読国際誌

Hideaki Kinugasa, Sakiko Hiraoka, Kazuhiro Nouso, Shumpei Yamamoto, Mami Hirai, Hiroyuki Terasawa, Eriko Yasutomi, Shohei Oka, Masayasu Ohmori, Yasushi Yamasaki, Toshihiro Inokuchi, Masahiro Takahara, Keita Harada, Takehiro Tanaka, Hiroyuki Okada

BMC cancer 20 ( 1 ) 1188 - 1188 2020年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: It is often difficult to diagnose inflammatory bowel disease (IBD)-associated neoplasia endoscopically due to background inflammation. In addition, due to the absence of sensitive tumor biomarkers, countermeasures against IBD-associated neoplasia are crucial. The purpose of this study is to develop a new diagnostic method through the application of liquid biopsy. METHODS: Ten patients with IBD-associated cancers and high-grade dysplasia (HGD) with preserved tumor tissue and blood were included. Tumor and non-tumor tissues were analyzed for 48 cancer-related genes using next-generation sequencing. Simultaneously, circulating tumor DNA (ctDNA) was analyzed for mutations in the target genes using digital PCR. RESULTS: Out of 10 patients, seven had IBD-related cancer and three had IBD-related HGD. Two patients had carcinoma in situ; moreover, three had stageII and two had stage III. To avoid false positives, the mutation rate cutoff was set at 5% based on the control results; seven of 10 (70%) tumor tissue samples were mutation-positive. Mutation frequencies for each gene were as follows: TP53 (20.9%; R136H), TP53 (25.0%; C110W), TP53 (8.5%; H140Q), TP53 (31.1%; R150W), TP53 (12.8%; R141H), KRAS (40.0%; G12V), and PIK3CA (34.1%; R 88Q). The same mutations were detected in the blood of these seven patients. However, no mutations were detected in the blood of the remaining three patients with no tumor tissue mutations. The concordance rate between tumor tissue DNA and blood ctDNA was 100%. CONCLUSION: Blood liquid biopsy has the potential to be a new method for non-invasive diagnosis of IBD-associated neoplasia.

DOI： 10.1186/s12885-020-07699-z

Transabdominal ultrasound sonography findings in peritonitis due to the spread of Crohn's disease to the penetration 査読国際誌

Masahiro Takahara, Sakiko Hiraoko, Hiroyuki Okada

Clinical Case Reports 8 ( 12 ) 3561 - 3562 2020年12月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Blackwell Publishing Ltd

In the presence of the clinical signs of peritonitis, transabdominal ultrasound sonography by experienced technicians or physicians could be a fast and reliable imaging tool for confirmation of disease status.

DOI： 10.1002/ccr3.3215

Evaluation of complete cold forceps polypectomy resection rate for 3- to 5-mm colorectal polyps. 査読国際誌

Yasushi Yamasaki, Keita Harada, Shumpei Yamamoto, Eriko Yasutomi, Mami Hirai, Masayasu Ohmori, Shohei Oka, Toshihiro Inokuchi, Hideaki Kinugasa, Yuusaku Sugihara, Masahiro Takahara, Sakiko Hiraoka, Takehiro Tanaka, Toshiharu Mitsuhashi, Hiroyuki Okada

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 33 ( 6 ) 948 - 954 2020年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND STUDY AIMS: The propriety of cold forceps polypectomy (CFP) using jumbo biopsy forceps for diminutive polyps remains controversial. We conducted a prospective study to evaluate the complete CFP resection rate of 3-5-mm polyps using additional endoscopic mucosal resection (EMR) specimens following CFP. PATIENTS AND METHODS: Patients with 3-5-mm protruded or flat elevated colorectal polyps diagnosed endoscopically as adenomas or serrated lesions were prospectively enrolled. CFP using jumbo biopsy forceps was used to remove the eligible polyps and repeated until the absence of residuals were confirmed via image-enhanced endoscopy or chromoendoscopy. After CFP, saline was injected at the defect, and the marginal specimen of the defect was resected using EMR to histologically evaluate the residue. The primary outcome was the complete CFP resection rate, which was defined as no residue at the EMR site. Other outcomes were the number of CFP bites and the complete resection rate by lesion size. RESULTS: Eighty patients with 120 polyps were enrolled. The mean polyp size was 4.1 ± 0.7 mm. The overall complete resection rate was 96.7% (95% confidence interval [CI], 91.7-98.7), and the rates for 3-, 4- and 5-mm polyps were 100% (95% CI, 86.7-100), 96.0% (95% CI, 86.5-98.9) and 95.5% (95% CI, 85.1-98.8), respectively. The one-bite CFP rates were 92%, 60% and 31% for the 3-, 4- and 5-mm polyps, respectively. CONCLUSIONS: The complete CFP resection rate for 3-5-mm polyps was acceptable, although the one-bite clearance rate decreased as the polyp size increased (UMIN000028841).

DOI： 10.1111/den.13895

潰瘍性大腸炎における経腹超音波検査の有用性

高原政宏, 平岡佐規子, 大森正泰, 安富絵里子, 岡昌平, 平井麻美, 井口俊博, 山本峻平, 山崎泰史, 衣笠秀明, 原田馨太, 大西秀爾, 岡田裕之

日本消化器病学会雑誌 117 ( 臨増大会 ) A706 - A706 2020年10月

潰瘍性大腸炎における経腹超音波検査の有用性

高原政宏, 平岡佐規子, 大森正泰, 安富絵里子, 岡昌平, 平井麻美, 井口俊博, 山本峻平, 山崎泰史, 衣笠秀明, 原田馨太, 大西秀爾, 岡田裕之

日本消化器病学会雑誌 117 ( 臨増大会 ) A706 - A706 2020年10月

Multiple Deep-seated Dentofacial Abscesses Caused by Multidrug-resistant Viridans Group Streptococci. 査読

Shinnosuke Fukushima, Hideharu Hagiya, Yuki Mizuta, Yasuhiro Nakano, Masahiro Takahara, Kayo Okamoto, Yuko Hayashi, Kiyoshi Yamada, Kou Hasegawa, Fumio Otsuka

Internal medicine (Tokyo, Japan) 59 ( 16 ) 2067 - 2070 2020年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

Odontogenic infections, generally caused by dental caries and periodontal disease, can result in fatal illness. We herein report a 71-year-old Japanese woman with type 2 diabetes and hemodialysis who suffered from multiple dentofacial abscesses mainly caused by multidrug-resistant Streptococcus oralis. She complained of pain and swelling of her face, with an extraoral fistula from the left cheek. Following 3 surgical debridement procedures and partial mandibulectomy, in addition to 12 weeks of antimicrobial therapy, the multiple dentofacial abscesses were ameliorated. A combination of surgical and antimicrobial treatments following an early diagnosis is essential for reducing further complications.

DOI： 10.2169/internalmedicine.4283-20

Factors Predicting a Favorable Disease Course Without Anti-TNF Therapy in Crohn's Disease Patients. 査読

Toshihiro Inokuchi, Sakiko Hiraoka, Eriko Yasutomi, Shohei Oka, Yasushi Yamasaki, Hideaki Kinugasa, Masahiro Takahara, Seiji Kawano, Keita Harada, Hiroyuki Okada, Jun Kato

Acta medica Okayama 74 ( 4 ) 265 - 274 2020年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

Determining factors that predict a favorable disease course without anti-tumor necrosis factor (TNF) agents would help establish a more cost-effective strategy for Crohn's disease (CD). A retrospective chart review was performed for CD patients with disease durations > 10 years who had not received anti-TNF agents as first-line therapy. Patients were divided into 2 groups: those who received neither anti-TNF agents nor bowel resection (G1), and those who had received an anti-TNF agent and/or bowel resection (G2). The patient backgrounds, therapies and clinical courses were compared between the groups. A total of 62 CD patients met the inclusion criteria (males: 71%; median duration of follow-up: 19 years). Six patients were included in G1; they were significantly less likely to have upper gastrointestinal lesions than G2 (p=0.007). A multivariate analysis revealed that the significant factors for avoidance of bowel resection without anti-TNF treatment were non-stricturing and non-penetrating behaviors, and absence of upper gastrointestinal lesions at the diagnosis (hazard ratios 0.41 and 0.52; p=0.004 and 0.04, respectively). In consideration of the long treatment course of CD, patients with non-stricturing and non-penetrating behaviors and no upper gastrointestinal lesions should not be treated with anti-TNF agents as first-line therapy.

DOI： 10.18926/AMO/60363

【分子標的時代のIBD診療-IBDの寛解導入,寛解維持の実践】IBD治療における寛解導入と寛解維持に関するトピック IBD寛解維持期における便中マーカーによるモニタリング

平岡佐規子, 安富絵里子, 岡昌平, 井口俊博, 高原政宏, 岡田裕之

臨床消化器内科 35 ( 10 ) 1256 - 1262 2020年8月

記述言語：日本語出版者・発行元：(株)日本メディカルセンター

＜文献概要＞炎症性腸疾患(IBD)診療における治療の選択肢は年々増えており,多くの患者に速やかな寛解導入,長期の寛解維持が望めるようになってきた.しかし,いったん寛解となっても再燃する場合はあり,その場合にはいかに早期に治療介入できるかが,重要となってくる.再燃を早期に発見するためには,臨床症状の確認とともに,粘膜治癒と相関し,かつ,非侵襲性で繰り返し測定可能なバイオマーカーをうまく利用することが重要である.バイオマーカーの有力な候補として,便中マーカーである便中カルプロテクチン,免疫学的便潜血法がある.臨床的寛解であっても継続的にそれら測定値の上昇を認めた場合は,再燃の可能性を考える必要がある.

当院における早期胃癌ESD非治癒切除症例の検討

山本高史, 竹中龍太, 矢杉賢吾, 平田翔一郎, 小幡泰介, 倉岡紗樹子, 平井伸典, 高原政宏, 河合大介, 堀圭介, 柘野浩史, 藤木茂篤

Gastroenterological Endoscopy 62 ( Suppl.1 ) 1249 - 1249 2020年8月

ベルベリンによる慢性腸炎マウスの腸内細菌叢の変化

高原政宏, 高木章乃夫, 平岡佐規子, 安富絵里子, 山本峻平, 岡昌平, 平井麻美, 山崎泰史, 井口俊博, 衣笠秀明, 原田馨太, 岡田裕之

日本消化器病学会雑誌 117 ( 臨増総会 ) A275 - A275 2020年7月

【皆で診る!IBD:多職種連携と地域医療】患者中心の医療 shared decision making(SDM)とは? メンタルケアも含めて

井口俊博, 平岡佐規子, 安富絵里子, 岡昌平, 高原政宏, 岡田裕之

IBD Research 14 ( 2 ) 82 - 86 2020年6月

記述言語：日本語出版者・発行元：(株)先端医学社

shared decision making(SDM)は困難な課題に対して医療従事者と患者とのあいだでなされるべき「意思決定の共有」であり、同時に合意形成をおこなうための重要なコミュニケーションツールである。炎症性腸疾患(IBD)は不均一な患者群で構成されているだけでなく、近年、検査や薬剤の開発が進み、診療の選択肢の幅が急激に増加し複雑化しているため、その診療における選択肢は多岐にわたり、SDMの重要性はいっそう増している。SDMを用いて、エビデンスに基づいたデータを患者の希望や価値観に沿った形で提供することで、患者の疾患に対する理解度、満足度は高まり、より良いIBD診療につなげることが可能となる。(著者抄録)

経皮肝腫瘍生検にて診断しえた末梢型T細胞リンパ腫の1例

大山淳史, 大西秀樹, 足立卓哉, 和田望, 高原政宏, 坂田雅浩, 安中哲也, 平岡佐規子, 丹羽知子, 戸田由香, 岡田裕之

日本消化器病学会中国支部例会プログラム・抄録集 113回 105 - 105 2020年5月

Observer agreement for the diagnosis of intestinal acute graft-vs.-host disease based on the presence of villous atrophy in the terminal ileum. 査読国際誌

Yuusaku Sugihara, Sakiko Hiraoka, Eriko Yasutomi, Shohei Oka, Yasushi Yamasaki, Toshihiro Inokuchi, Hideaki Kinugasa, Masahiro Takahara, Yuki Morito, Sakuma Takahashi, Keita Harada, Takehiro Tanaka, Fumio Otsuka, Hiroyuki Okada

Experimental and therapeutic medicine 19 ( 4 ) 3076 - 3080 2020年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Intestinal graft-vs.-host disease (GVHD) is a serious complication of allo-hematopoietic stem cell transplantation (allo-HSCT). Villous atrophy in the terminal ileum is considered a useful diagnostic indicator for GVHD. However, the inter- and intra-observer agreement regarding the ileocolonoscopic findings indicative of acute intestinal GVHD, i.e., villous atrophy in the terminal ileum, are currently insufficient in multiple institutions. Thus, the present study aimed to investigate the incidence of villous atrophy in the terminal ileum to diagnose acute intestinal GVHD and determine the inter- and intra-observer agreement regarding this result for experienced endoscopists from multiple institutions. Consecutive patients who underwent allo-HSCT were referred to our institution between May 2008 and September 2015. A total of 54 patients underwent total ileocolonoscopy after allo-HSCT due to suspected intestinal acute GVHD. Subsequently, three observers from different institutions evaluated the cases for the presence of villous atrophy in the terminal ileum. In this study, the pathology results were a gold standard to evaluate the predictive value of ileocolonoscopy detection. Definitive pathological and non-pathological GVHD was diagnosed in 22 and 32 cases, respectively. The results of examining whether villous atrophy could predict GVHD were as follows. For three observers (A, B and C), the sensitivity of villous atrophy in the terminal ileum was 86.4, 77.3 and 79.2%, respectively, whereas the specificity was 62.5, 62.5 and 86.7%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of villous atrophy for GVHD were as follows: The PPV of appearance was 61.3, 58.6 and 82.6%, respectively, whereas the NPV was 87.0, 80.0 and 83.9%, respectively. Kappa coefficients for the inter-observer reliability were 0.85, 0.63 and 0.63 for observers A and B, A and C, and B and C, respectively. The intra-observer kappa coefficient was 0.88 for observer A, 0.73 for observer B and 0.75 for observer C. A substantial observer agreement was achieved for the analysis of villous atrophy in the terminal ileum and the agreement for the predictive histological diagnosis was also excellent. Based on the results of the present study, identification of villous atrophy in the terminal ileum was a clinically effective diagnostic parameter, even if different endoscopists were involved in the diagnosis at multiple institutions. The present study was registered as a trial with the University Hospital Medical Information Network (UMIN; registration no. UMIN000025390).

DOI： 10.3892/etm.2020.8538

潰瘍性大腸炎における経腹超音波検査の有用性

高原政宏, 平岡佐規子, 安富絵里子, 岡昌平, 平井麻美, 井口俊博, 竹中龍太, 藤木茂篤, 岡田裕之

日本内科学会雑誌 109 ( Suppl. ) 188 - 188 2020年2月

レーザー内視鏡診療の現状と近未来浸水下での大腸ポリープ境界診断におけるBLI/LCIの有効性を評価するための後ろ向き観察研究

山崎泰史, 原田馨太, 安富絵里子, 山本峻平, 岡昌平, 平井麻美, 井口俊博, 衣笠秀明, 高原政宏, 平岡佐規子, 岡田裕之

日本消化管学会雑誌 4 ( Suppl. ) 223 - 223 2020年1月

倦怠感で発症し急速な経過で下垂体不全を来した視床下部原発悪性リンパ腫の1例

高瀬了輔, 中野靖浩, 水田有紀, 安田美帆, 長谷川功, 高原政宏, 萩谷英大, 大塚文男

日本内分泌学会雑誌 95 ( 3 ) 1173 - 1173 2020年1月

Switching between Three Types of Mesalazine Formulation and Sulfasalazine in Patients with Active Ulcerative Colitis Who Have Already Received High-Dose Treatment with These Agents. 査読国際誌

Yasutomi E, Hiraoka S, Yamamoto S, Oka S, Hirai M, Yamasaki Y, Inokuchi T, Kinugasa H, Takahara M, Harada K, Kato J, Okada H

Journal of clinical medicine 8 ( 12 ) 2019年12月

膵癌におけるFNA検体と切除検体とのPD-L1発現の検討

松本和幸, 高木章乃夫, 大原利章, 藤澤真義, 高原政宏, 加藤博也, 吉田龍一, 楳田祐三, 八木孝仁, 松川昭博, 岡田裕之

日本消化器病学会雑誌 116 ( 臨増大会 ) A826 - A826 2019年11月

【これ一冊でわかる炎症性腸疾患診療のすべて】炎症性腸疾患のバイオマーカー

平岡佐規子, 安富絵里子, 岡昌平, 山崎泰史, 井口俊博, 高原政宏, 衣笠秀明, 原田馨太, 近藤喜太, 加藤順, 岡田裕之

消化器外科 42 ( 12 ) 1653 - 1662 2019年11月

リンパ節の再生検からHodgkinリンパ腫の診断に至った不明熱の1例

荒木晴, 徳増一樹, 原田洸, 山本晃, 高原政宏, 長谷川功, 萩谷英大, 花山宜久, 大塚文男

日本病院総合診療医学会雑誌 15 ( 6 ) 602 - 602 2019年11月

直腸顆粒細胞腫(Granular Cell Tumor)の1例

深田悠史, 衣笠秀明, 山本俊平, 平井麻美, 安富絵里子, 岡昌平, 山崎泰史, 井口俊博, 高原政宏, 原田馨太, 平岡佐規子, 田中健大, 岡田裕之

日本消化器病学会中国支部例会プログラム・抄録集 112回 146 - 146 2019年11月

蘇生後にサイトメガロウイルス腸炎を発症し、胃気腫症と腸管偽リポマトーシスを合併した一例

山内菜緒, 岩室雅也, 田中健大, 中島有理, 和田嵩平, 高原政宏, 川野誠司, 平岡佐規子, 河原祥朗, 岡田裕之

日本消化器病学会中国支部例会プログラム・抄録集 112回 83 - 83 2019年11月

Blue laser imaging and linked color imaging improve the color difference value and visibility of colorectal polyps in underwater conditions. 査読国際誌

Yamasaki Y, Harada K, Yamamoto S, Yasutomi E, Okanoue S, Hirai M, Oka S, Obayashi Y, Sakae H, Hamada K, Inokuchi T, Kinugasa H, Sugihara Y, Takahara M, Tanaka T, Hiraoka S, Kawahara Y, Okada H

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 32 ( 5 ) 791 - 800 2019年11月

膵癌におけるFNA検体と切除検体とのPD-L1発現の検討査読

松本和幸, 高木章乃夫, 大原利章, 藤澤真義, 高原政宏, 加藤博也, 吉田龍一, 楳田祐三, 八木孝仁, 松川昭博, 岡田裕之

日本消化器病学会雑誌 116 ( 臨増大会 ) A826 - A826 2019年11月

The relationship between the PD-L1 expression of surgically resected and fine-needle aspiration specimens for patients with pancreatic cancer. 査読

Kazuyuki Matsumoto, Toshiaki Ohara, Masayoshi Fujisawa, Akinobu Takaki, Masahiro Takahara, Noriyuki Tanaka, Hironari Kato, Shigeru Horiguchi, Ryuichi Yoshida, Yuzo Umeda, Soichiro Fushimi, Takahito Yagi, Akihiro Matsukawa, Hiroyuki Okada

Journal of gastroenterology 54 ( 11 ) 1019 - 1028 2019年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Recently, therapeutic antibodies against programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) have shown promising clinical results for several solid tumors, including pancreatic cancer. In this study, we evaluated the relationship between the PD-L1 expression of surgical resected and fine-needle aspiration (FNA) specimens for patients with pancreatic cancer. METHODS: Of 121 patients who underwent endoscopic ultrasound-guided (EUS)-FNA before surgery for pancreatic cancer in an academic center, the 94 (78%) with adequate FNA specimens for a histological evaluation were retrospectively analyzed. All the patients had undergone upfront surgery without any chemotherapy or radiotherapy. We performed immunohistochemistry (IHC) staining to investigate the PD-L1 expression in both resected and FNA specimens. The positive-stained cells were counted, and their percentage was used for the investigation. RESULTS: Of the 94 patients, 16 (17%) and 11 (10%) were defined as positive on resected cancer specimens using cutoff points of 5% and 10% positively stained cancer cell counts, respectively. The concordance rates for the positive frequency of PD-L1 expression between resected and FNA specimens were 44% (7/16) and 55% (6/11) when the positivity was set to ≥ 5% and ≥ 10%, respectively. The concordance rates for the negative frequency of PD-L1 expression between two specimens were 97% (76/78) and 99% (82/83) when the positivity was set to ≥ 5% and ≥ 10%, respectively. CONCLUSIONS: Approximately, half of the patients with PD-L1 expression positive and almost all the patients with PD-L1 expression negative could be diagnosed on FNA specimens.

DOI： 10.1007/s00535-019-01586-6

High-resolution melt analysis enables simple genotyping of complicated polymorphisms of codon 18 rendering the NUDT15 diplotype 査読

JOURNAL OF GASTROENTEROLOGY 55 ( 1 ) 67 - 77 2019年10月

A Granulation Polyp in the Colon Masquerading as Metastatic Cancer. 査読

Iwamuro M, Takahara M, Yamazaki T, Tanaka T, Kondo Y, Hiraoka S, Okada H

Acta medica Okayama 73 ( 5 ) 457 - 461 2019年10月

急激に下垂体機能低下を生じた視床下部原発悪性リンパ腫の1例

高瀬了輔, 中野靖浩, 水田有紀, 安田美帆, 長谷川功, 高原政宏, 萩谷英大, 大塚文男

日本内分泌学会雑誌 95 ( 2 ) 716 - 716 2019年10月

浸水下での大腸ポリープ境界診断におけるLCI/BLIの有効性を評価するための遡及的研究

山崎泰史, 原田馨太, 安富絵里子, 岡昌平, 平井麻美, 井口俊博, 衣笠秀明, 高原政宏, 平岡佐規子, 岡田裕之

Gastroenterological Endoscopy 61 ( Suppl.2 ) 2167 - 2167 2019年10月

クローン病の内視鏡スコア変化予測には血清Alb値が有用である

井口俊博, 平岡佐規子, 安富絵里子, 平井麻美, 岡昌平, 山崎泰史, 杉原雄策, 衣笠秀明, 高原政宏, 原田馨太, 川野誠司, 岡田裕之

Gastroenterological Endoscopy 61 ( Suppl.2 ) 2181 - 2181 2019年10月

Transabdominal Ultrasonographic Findings of Gastrointestinal Lymphoproliferative Disease. 査読

Takahara M, Hiraoko S, Okada H

Internal medicine (Tokyo, Japan) 59 ( 3 ) 453 - 454 2019年9月

Berberine improved experimental chronic colitis by regulating interferon-γ- and IL-17A-producing lamina propria CD4⁺ T cells through AMPK activation. 査読国際誌

Takahara M, Takaki A, Hiraoka S, Adachi T, Shimomura Y, Matsushita H, Nguyen TTT, Koike K, Ikeda A, Takashima S, Yamasaki Y, Inokuchi T, Kinugasa H, Sugihara Y, Harada K, Eikawa S, Morita H, Udono H, Okada H

Scientific reports 9 ( 1 ) 11934 - 11934 2019年8月

超拡大内視鏡画像診断における「EC分類」はレクチャーにより初学者にも実行可能となるか

杉原雄策, 原田馨太, 岡田裕之, 安富絵里子, 岡昌平, 榮浩行, 山崎泰史, 井口俊博, 衣笠秀明, 高原政宏, 平岡佐規子, 河原祥朗

Gastroenterological Endoscopy 61 ( Suppl.1 ) 871 - 871 2019年5月

Mesenteric follicular lymphoma. 査読国際誌

Nishimura Y, Yamamoto A, Takahara M, Otsuka F

Clinical case reports 7 ( 5 ) 1108 - 1109 2019年5月

苦痛の少ない大腸内視鏡検査を実現するための患者選択の工夫

岡昌平, 原田馨太, 岡田裕之, 安富絵里子, 平井麻美, 山崎泰史, 井口俊博, 杉原雄策, 高原政宏, 衣笠秀明, 平岡佐規子

Gastroenterological Endoscopy 61 ( Suppl.1 ) 876 - 876 2019年5月

潰瘍性大腸炎に合併したMixed Neuroendocrine-Non-Neuroendocrine Neoplasmsの一例

永原崇甫, 衣笠秀明, 岡昌平, 安富絵里子, 平井麻美, 山本俊平, 山崎泰史, 井口俊博, 杉原雄策, 高原政宏, 原田馨太, 平岡佐規子, 近藤喜太, 田中健大, 岡田裕之

日本消化器病学会中国支部例会プログラム・抄録集 111回 72 - 72 2019年5月

インフリキシマブにより臨床的寛解を得たにも関わらず、突然に回腸腸間膜穿通をきたしたクローン病の一例

安富絵里子, 井口俊博, 岡昌平, 平井麻美, 山崎泰史, 衣笠秀明, 高原政宏, 川野誠司, 原田馨太, 平岡佐規子, 岡田裕之, 高橋一剛, 近藤善太, 田中健大

日本消化器病学会中国支部例会プログラム・抄録集 111回 86 - 86 2019年5月

中毒性巨大結腸症を合併していた重症潰瘍性大腸炎の一例

岡昌平, 高原政宏, 平岡佐規子, 安富絵里子, 井口俊博, 平井麻美, 山崎泰史, 杉原雄策, 衣笠秀明, 原田馨太, 高橋一剛, 近藤喜太, 岡田裕之

日本消化器病学会中国支部例会プログラム・抄録集 111回 87 - 87 2019年5月

THE RELATIONSHIP BETWEEN THE PD-L1 EXPRESSION OF SURGICAL RESECTED AND FINE-NEEDLE ASPIRATION SPECIMENS FOR PATIENTS WITH PANCREATIC CANCER 査読

Matsumoto Kazuyuki, Ohara Toshiaki, Fujisawa Masayoshi, Takaki Akinobu, Takahara Masahiro, Kato Hironari, Horiguchi Shigeru, Matsukawa Akihiro, Okada Hiroyuki

GASTROENTEROLOGY 156 ( 6 ) S758 2019年5月

The novel latex agglutination turbidimetric immunoassay system for simultaneous measurements of calprotectin and hemoglobin in feces. 査読国際誌

Hiraoka S, Takashima S, Inokuchi T, Nakarai A, Takahara M, Harada K, Seki Y, Watanabe K, Kato J, Okada H

Intestinal research 17 ( 2 ) 202 - 209 2019年4月

Paradoxical Roles of Oxidative Stress Response in the Digestive System before and after Carcinogenesis. 査読国際誌

Takaki A, Kawano S, Uchida D, Takahara M, Hiraoka S, Okada H

Cancers 11 ( 2 ) 2019年2月

Comparison of Two Electrosurgical Modes for Endoscopic Submucosal Dissection of Superficial Colorectal Neoplasms: A Prospective Randomized Study. 査読

Sugihara Y, Harada K, Oka S, Yasutomi E, Yamasaki Y, Inokuchi T, Kinugasa H, Takahara M, Hiraoka S, Otsuka F, Okada H

Acta medica Okayama 73 ( 1 ) 81 - 84 2019年2月

Cognitive decline due to ectopic primary hyperparathyroidism. 査読国際誌

Nishimura Y, Yamamoto A, Takahara M, Otsuka F

Clinical case reports 6 ( 12 ) 2513 - 2514 2018年12月

大腸ESD後創部に対する浸水下クリップ縫縮法単施設実施可能性試験

山崎泰史, 原田馨太, 岡昌平, 高嶋志保, 井口俊博, 杉原雄策, 高原政宏, 平岡佐規子, 岡田裕之

Gastroenterological Endoscopy 60 ( Suppl.2 ) 2074 - 2074 2018年10月

CAPの今後の課題、高齢者や妊娠患者などの特殊症例に対するCAPの有効性と安全性安全性の高いCAP療法をいかに使うか岡山大学病院の試み

井口俊博, 平岡佐規子, 安富絵里子, 岡昌平, 高原政宏, 岡田裕之

日本アフェレシス学会雑誌 37 ( Suppl. ) 61 - 61 2018年10月

Feasibility of Underwater Clip Closure for Large Mucosal Defects after Colorectal Endoscopic Submucosal Dissection. 査読国際誌

Yamasaki Y, Harada K, Oka S, Takashima S, Inokuchi T, Sugihara Y, Takahara M, Hiraoka S, Okada H

Digestion 99 ( 4 ) 1 - 6 2018年9月

NUDT15 codon 139 is the best pharmacogenetic marker for predicting thiopurine-induced severe adverse events in Japanese patients with inflammatory bowel disease: a multicenter study. 査読

Yoichi Kakuta, Yosuke Kawai, Daisuke Okamoto, Tetsuya Takagawa, Kentaro Ikeya, Hirotake Sakuraba, Atsushi Nishida, Shoko Nakagawa, Miki Miura, Takahiko Toyonaga, Kei Onodera, Masaru Shinozaki, Yoh Ishiguro, Shinta Mizuno, Masahiro Takahara, Shunichi Yanai, Ryota Hokari, Tomoo Nakagawa, Hiroshi Araki, Satoshi Motoya, Takeo Naito, Rintaro Moroi, Hisashi Shiga, Katsuya Endo, Taku Kobayashi, Makoto Naganuma, Sakiko Hiraoka, Takayuki Matsumoto, Shiro Nakamura, Hiroshi Nakase, Tadakazu Hisamatsu, Makoto Sasaki, Hiroyuki Hanai, Akira Andoh, Masao Nagasaki, Yoshitaka Kinouchi, Tooru Shimosegawa, Atsushi Masamune, Yasuo Suzuki

Journal of gastroenterology 53 ( 9 ) 1065 - 1078 2018年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Despite NUDT15 variants showing significant association with thiopurine-induced adverse events (AEs) in Asians, it remains unclear which variants of NUDT15 or whether additional genetic variants should be tested to predict AEs. To clarify the best pharmacogenetic test to be used clinically, we performed association studies of NUDT15 variants and haplotypes with AEs, genome-wide association study (GWAS) to discover additional variants, and ROC analysis to select the model to predict severe AEs. METHODS: Overall, 2630 patients with inflammatory bowel disease (IBD) were enrolled and genotyped for NUDT15 codon 139; 1291 patients were treated with thiopurines. diplotypes were analyzed in 970 patients, and GWASs of AEs were performed with 1221 patients using population-optimized genotyping array and imputation. RESULTS: We confirmed the association of NUDT15 p.Arg139Cys with leukopenia and alopecia (p = 2.20E-63, 1.32E-69, OR = 6.59, 12.1, respectively), and found a novel association with digestive symptoms (p = 6.39E-04, OR = 1.89). Time to leukopenia was significantly shorter, and when leukopenia was diagnosed, thiopurine doses were significantly lower in Arg/Cys and Cys/Cys than in Arg/Arg. In GWASs, no additional variants were found to be associated with thiopurine-induced AEs. Despite strong correlation of leukopenia frequency with estimated enzyme activities based on the diplotypes (r2 = 0.926, p = 0.0087), there were no significant differences in the AUCs of diplotypes from those of codon 139 to predict severe AEs (AUC = 0.916, 0.921, for acute severe leukopenia, AUC = 0.990, 0.991, for severe alopecia, respectively). CONCLUSIONS: Genotyping of NUDT15 codon 139 was sufficient to predict acute severe leukopenia and alopecia in Japanese patients with IBD.

DOI： 10.1007/s00535-018-1486-7

食道アカラシアバルーン拡張術およびHeller-Dor手術施行後の下部食道運動異常に対しPOEM(peroral endoscopic myotomy)が著効した1例

杉原雄策, 原田馨太, 加藤諒, 山内健司, 高嶋志保, 山崎泰史, 井口俊博, 高原政宏, 川野誠司, 平岡佐規子, 眞部紀明, 大塚文男, 岡田裕之

岡山医学会雑誌 130 ( 2 ) 67 - 71 2018年8月

記述言語：日本語出版者・発行元：岡山医学会

症例は80歳代男性で、約60年前に嚥下障害を発症し、食道アカラシアと診断されていた。約15年前に症状が悪化し、食道アカラシアバルーン拡張術を2回施行された。一旦は症状が改善したが、5年前に再度悪化をきたし、Heller-Dor手術を施行された。症状は改善していたが、1年前より嚥下障害と嘔吐が出現した。アカラシアバルーン拡張術およびHeller-Dor手術を施行後、新たに発生した下部食道の運動異常と、それに伴う逆流が、症状再発の原因と診断し、経口内視鏡下筋層切開術(POEM)を施行した。下部食道の運動異常は消失し、バリウムの逆流も認めなかった。経過は良好で、術後4病日に退院となった。現在まで、症状の悪化や再発はきたしていない。

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00175&link_issn=&doc_id=20180806220002&doc_link_id=10.4044%2Fjoma.130.67&url=https%3A%2F%2Fdoi.org%2F10.4044%2Fjoma.130.67&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Villous atrophy in the terminal ileum is a specific endoscopic finding correlated with histological evidence and poor prognosis in acute graft-versus-host disease after allo-hematopoietic stem cell transplantation. 査読国際誌

Sugihara Y, Hiraoka S, Fujii N, Takashima S, Yamasaki Y, Inokuchi T, Takahara M, Kuwaki K, Harada K, Tanaka T, Okada H

BMC gastroenterology 18 ( 1 ) 111 - 111 2018年7月

An Elevated Platelet Count Increases the Risk of Relapse in Ulcerative Colitis Patients with Mucosal Healing. 査読国際誌

Nakarai A, Kato J, Hiraoka S, Takashima S, Inokuchi T, Takahara M, Sugihara Y, Harada K, Okada H

Gut and liver 12 ( 4 ) 420 - 425 2018年7月

血漿中interleukin-1 receptor antagonistは潰瘍性大腸炎の内視鏡的活動性の予測に有用である

高嶋志保, 平岡佐規子, 井口俊博, 半井明日香, 稲葉知己, 吉岡正雄, 竹本浩二, 松枝和宏, 高原政宏, 原田馨太, 岡田裕之

Gastroenterological Endoscopy 60 ( Suppl.1 ) 801 - 801 2018年4月

急性消化管GVHDの診断における上部消化管内視鏡検査と大腸内視鏡検査の比較

杉原雄策, 平岡佐規子, 加藤諒, 高嶋志保, 山崎泰史, 井口俊博, 高原政宏, 原田馨太, 藤井伸治, 田中健大, 岡田裕之

Gastroenterological Endoscopy 60 ( Suppl.1 ) 772 - 772 2018年4月

粘膜治癒を達成した潰瘍性大腸炎患者において血小板数は再燃予測マーカーとなる

半井明日香, 平岡佐規子, 高嶋志保, 岡昌平, 山崎泰史, 井口俊博, 杉原雄策, 高原政宏, 原田馨太, 加藤順, 岡田裕之

Gastroenterological Endoscopy 60 ( Suppl.1 ) 801 - 801 2018年4月

Ten Initial Cases of Peroral Endoscopic Myotomy for Treatment of Esophageal Motility Disorders at Okayama University Hospital. 査読

Sugihara Y, Harada K, Kato R, Yamauchi K, Takashima S, Takei D, Yamasaki Y, Inokuchi T, Takahara M, Hiraoka S, Okada H

Acta medica Okayama 72 ( 2 ) 99 - 104 2018年4月

Evaluation of the Upper Gastrointestinal Tract in Ulcerative Colitis Patients. 査読

Kato R, Iwamuro M, Hiraoka S, Takashima S, Inokuchi T, Takahara M, Kondo Y, Tanaka T, Okada H

Acta medica Okayama 72 ( 2 ) 105 - 113 2018年4月

パテンシーカプセルが回腸に長期滞留したクローン病の1例

岩室雅也, 高嶋志保, 井口俊博, 高原政宏, 川野誠司, 平岡佐規子, 近藤喜太, 田中健大, 岡田裕之

日本消化器病学会雑誌 115 ( 2 ) 203 - 210 2018年2月

記述言語：日本語出版者・発行元：(一財)日本消化器病学会

40歳男性。21歳時にクローン病と診断され加療中。イレウス症状を繰り返すため当院紹介。CT検査では回腸狭窄および同部位に高吸収の人工物を認めた。ダブルバルーン内視鏡検査では回腸に多発狭窄を認め、小腸部分切除を施行したところ、狭窄部の近位側に異物を認めた。抽出した異物の解析により、30ヵ月前に嚥下したパテンシーカプセルの非溶解性コーティング膜の滞留と診断した。(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01118&link_issn=&doc_id=20180223480008&doc_link_id=130006379165&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130006379165&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Simultaneous measurements of faecal calprotectin and the faecal immunochemical test in quiescent ulcerative colitis patients can stratify risk of relapse 査読国際誌

Asuka Nakarai, Sakiko Hiraoka, Sakuma Takahashi, Tomoki Inaba, Reiji Higashi, Motowo Mizuno, Shiho Takashima, Toshihiro Inokuchi, Yuusaku Sugihara, Masahiro Takahara, Keita Harada, Jun Kato, Hiroyuki Okada

Journal of Crohn's and Colitis 12 ( 1 ) 71 - 76 2018年1月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Oxford University Press

Background: Both faecal calprotectin [Fcal] and the faecal immunochemical test [FIT] are useful to predict clinical relapse of ulcerative colitis [UC]. However, the difference between Fcal and FIT in ability to predict relapse has scarcely been reported. Whether the combined use of these two faecal markers increases the predictability is also unknown. Methods: UC patients in clinical remission who underwent colonoscopy were enrolled prospectively, and the Fcal and FIT values were examined at enrolment. Their clinical course was observed for 2 years or until relapse. The correlation between the incidence of relapse and the values of the two markers was examined. Results: A total of 113 patients were enrolled, and 48 [42%] relapsed. Fcal = 75 μg/g and FIT = 110 ng/mL were defined as Fcal-positive and FIT-positive, respectively, according to the receiver operating characteristic curves. Both Fcal-positive and FIT-positive statuses were independent predictive factors of clinical relapse (hazard ratio [HR] 2.29
95% confidence interval [CI], 1.23-4.49
p = 0.0086, and HR 2.91
95% CI, 1.49-5.50
p = 0.0022, respectively). Categorisation of patients into three groups according to the faecal marker status [FIT-positive, FIT-negative and Fcal-positive, and both negative] can efficiently stratify the risk of relapse with graded increases in risk [FIT-negative and Fcal-positive: HR 2.05
95% CI, 1.02-4.43
p = 0.0045, and FIT-positive: HR 5.43
95% CI, 2.57- 11.76
p &lt
0.0001, compared with both negative]. Conclusions: Fcal vs FIT showed distinct properties regarding the prediction of relapse in UC. A risk assessment using both faecal markers could increase the predictability for relapse.

DOI： 10.1093/ecco-jcc/jjx118

Retention of patency capsule in a patient with Crohn's disease 査読

Masaya Iwamura, Shiho Takashima, Toshihiro Iguchi, Masahiro Takahara, Seiji Kawano, Satiko Hiraoka, Yuta Kondo, Takehi Tanaka, Hiroyuki Okada

Journal of Japanese Society of Gastroenterology 115 ( 2 ) 203 - 210 2018年

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Japanese Society of Gastroenterology

A 40-year-old Japanese man with abdominal pain was referred to our hospital. The patient had been diagnosed with Crohn's disease at the age of 21 years and had since then received treatment with mesalazine and had been advocated an elemental diet. About 30 months before his visit to the hospital, he had swallowed a patency capsule, the retention of which in the ileum was subsequently detected on abdominal ultrasonography. The patient was advised to undergo the evaluation of stenosis, but he refused further investigation at that time. Computed tomography scanning performed at our institution revealed stenosis of the ileum and the presence of a high-density material in the proximal side of the stenosis. Double-balloon enteroscopy and enterography with contrast media revealed multiple stenoses of the ileum. The stenotic ileum was surgically resected, and a foreign body was removed. Electron microscopy analysis revealed that the foreign body was the cellophane wall of the PillCamTM patency capsule. Thus, the retention of the cellophane wall of a patency capsule after consumption was diagnosed for the current case on the basis of the study findings.

DOI： 10.11405/nisshoshi.115.203

Efficacy of restarting anti-tumor necrosis factor α agents after surgery in patients with Crohn's disease. 査読国際誌

Hiraoka S, Takashima S, Kondo Y, Inokuchi T, Sugihara Y, Takahara M, Kawano S, Harada K, Kato J, Okada H

Intestinal research 16 ( 1 ) 75 - 82 2018年

Findings of Retrograde Contrast Study Through Double-balloon Enteroscopy Predict the Risk of Bowel Resections in Patients with Crohn's Disease with Small Bowel Stenosis 査読国際誌

Noriko Okazaki, Toshihiro Inokuchi, Sakiko Hiraoka, Masayasu Ohmori, Shiho Takashima, Daisuke Takei, Yuusaku Sugihara, Masahiro Takahara, Keita Harada, Seiji Kawano, Hiroyuki Okada, Jun Kato

INFLAMMATORY BOWEL DISEASES 23 ( 12 ) 2097 - 2103 2017年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

Background: Patients with Crohn's disease (CD) with small bowel strictures are at risk of surgery. Double-balloon enteroscopy (DBE) can evaluate the status of the small intestine, and retrograde contrast through the scope enables the surgeon to obtain information beyond the reach of the scope. This study aimed to examine whether a retrograde contrast study through DBE could be used as a predictor of subsequent surgery in patients with CD with small intestinal strictures.
Methods: The findings of DBE with retrograde contrast in 48 patients CD with small bowel strictures were examined.
Results: Of the 48 patients, 14 (29%) underwent surgery for small intestinal strictures during a median observation period of 2.4 years (interquartile range: 1.4-3.7 yr). According to the results of the multivariate analysis, a maximum length of strictures >= 20 mm and the ratio of the maximum diameter of prestenotic dilations to the diameter of the normal small intestine >= 1.4 were independent risk factors of surgery for small intestinal strictures (risk ratio = 7.6 [95% confidence interval, 1.8-42.0], P = 0.006; and risk ratio = 52.0 [95% confidence interval, 3.5-2485.1], P = 0.002, respectively). The latter predicted subsequent surgery with 92% sensitivity and 88% specificity. Cumulative surgery-free rates were discriminated significantly according to the presence or absence of these 2 risk factors (log-rank test: P < 0.001).
Conclusions: Findings of retrograde contrast through DBE are helpful to predict risk of surgery in patients with CD with small intestinal strictures.

DOI： 10.1097/MIB.0000000000001175

大腸・小腸疾患に対する診断の進歩ラテックス凝集法を用いた新規便中カルプロテクチン測定法における潰瘍性大腸炎患者の粘膜治癒検出能の検討

平岡佐規子, 井口俊博, 半井明日香, 高嶋志保, 山崎泰史, 杉原雄策, 高原政宏, 原田馨太, 関泰宏, 渡辺勝紀, 岡田裕之

日本大腸肛門病学会雑誌 70 ( 抄録号 ) A68 - A68 2017年9月

大腸内視鏡を用いた急性GVHDの診断における「回腸末端の絨毛の萎縮」の臨床的意義後方視的多施設共同研究

杉原雄策, 平岡佐規子, 高嶋志保, 竹井大介, 井口俊博, 高原政宏, 森藤由紀, 高橋索真, 桑木健志, 原田馨太, 藤井伸治, 田中健大, 岡田裕之

Gastroenterological Endoscopy 59 ( Suppl.2 ) 2238 - 2238 2017年9月

術前精査でSM癌と診断した大腸腫瘍の行く末

原田馨太, 赤穂宗一郎, 榮浩行, 高嶋志保, 井口俊博, 竹井大介, 杉原雄策, 高原政宏, 平岡佐規子, 河原祥朗, 岡田裕之

Gastroenterological Endoscopy 59 ( Suppl.2 ) 2174 - 2174 2017年9月

POEM(Per-Oral Endoscopic Myotomy)を施行した食道アカラシアの1例

杉原雄策, 原田馨太, 加藤諒, 山内健司, 高嶋志保, 竹井大介, 井口俊博, 高原政宏, 川野誠司, 平岡佐規子, 田辺俊介, 野間和宏, 白川靖博, 眞部紀明, 井上晴洋, 岡田裕之

岡山医学会雑誌 129 ( 2 ) 115 - 121 2017年8月

記述言語：日本語出版者・発行元：岡山医学会

39歳男。食事摂取後の嚥下困難を主訴に近医受診し、上部消化管内視鏡検査で食道アカラシアと診断され、精査加療目的に当院紹介となった。食道X線造影検査(バリウム50ml内服)で食道内に5分間以上のバリウム停滞を認め、異常蠕動を認めた。高解像度食道内圧検査(嚥下試験)で下部食道の収縮圧は24mmHgであり、胃食道接合部の弛緩は認めなかった。これらの所見から、食道アカラシアのシカゴ分類type Iと診断し、POEMを施行した。翌日の食道X線造影検査でバリウムは速やかに胃内へ流入することが確認され、その後の経過も良好で、術後4日目に退院となり、1年後の現在まで症状の再燃は認めていない。

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00175&link_issn=&doc_id=20170817260005&doc_link_id=10.4044%2Fjoma.129.115&url=https%3A%2F%2Fdoi.org%2F10.4044%2Fjoma.129.115&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Acute Appendicitis Caused by Previous Endoscopic Submucosal Dissection for an Adenoma Adjacent to the Appendiceal Orifice. 査読国際誌

Kato R, Harada K, Harada K, Takei D, Sugihara Y, Takashima S, Inokuchi T, Takahara M, Hiraoka S, Omura Y, Oda W, Okada H

Case reports in gastroenterology 11 ( 2 ) 271 - 276 2017年5月

Mucosectom2とSB knife Jr.の大腸の粘膜下層剥離術における前向き無作為比較試験

杉原雄策, 原田馨太, 河原祥朗, 高嶋志保, 竹井大介, 井口俊博, 高原政宏, 桑木健志, 平岡佐規子, 岡田裕之

Gastroenterological Endoscopy 59 ( Suppl.1 ) 944 - 944 2017年4月

P2-10 慢性腸炎マウスモデルにおけるベルベリンの改善効果と作用機序の検討

高原政宏, 高木章乃夫, 平岡佐規子, 池田愛璃, 足立卓哉, 松下浩志, 小池和子, 岡田裕之

日本臨床免疫学会会誌 40 ( 4 ) 311b - 311b 2017年

記述言語：日本語出版者・発行元：日本臨床免疫学会

<p>【背景】生薬であるベルベリン（BBR）は下痢止めとして臨床応用されているが，抗炎症など多彩な作用も有することが明らかになっている．BBRは細胞のエネルギーの調節因子であるAMPKを活性化させることが知られており，近年，このAMPKがT細胞を含む免疫細胞の応答に関わっていることが報告されている．【目的，方法】慢性腸炎マウスモデルを用いて，大腸炎粘膜のCD4⁺T細胞（LP CD4⁺T細胞）におけるBBRの抗炎症作用とその機序についての検証をin vitroおよびIn vivoで行う．1）CD4⁺CD45RB^highT細胞移入腸炎マウスのLPCD4⁺T細胞をPMA/Ionomysinで刺激し，IFN-γ産生細胞を誘導，BBRの効果について，AMPKの関与も含めて検討．2）上記腸炎マウスにBBRを含んだ餌を投与し，腸炎の抑制効果について検討．【結果】1）LP CD4⁺T細胞はBBRと共培養すると，IFN-γ産生細胞が優位に低下し，ウェスタンブロッティングでは，AMPKの活性化を認めた．次に，AMPKのagonistとantagonistを用いた培養系でIFN-γの産生を調べたところ，agonistで抑制，antagonistで増加を認めた．以上から，BBRにより活性化されたAMPKがIFN-γを制御していることが示唆された．2）上記腸炎マウスにBBRを経口投与した結果，腸炎は優位に抑制された．【結論】BBRは，慢性腸炎マウスモデルの腸炎を抑制し，その作用機序の一つとしてAMPKを介した機序が示唆された．</p>

DOI： 10.2177/jsci.40.311b

家族性大腸腺腫症術後20年後に小腸癌を発症した1例

杉原雄策, 川野誠司, 原田馨太, 高嶋志保, 竹井大介, 井口俊博, 高原政宏, 平岡佐規子, 母里淑子, 岸本浩行, 永坂岳司, 岡田裕之

岡山医学会雑誌 129 ( 2 ) 111 - 114 2017年

記述言語：日本語出版者・発行元：岡山医学会

&emsp;A 58-year-old Japanese man visited a local clinic for the evaluation of a stomachache. He was diagnosed with intestinal obstruction. His medical history included a proctocolectomy at the age of 38 years, due to familial adenomatous polyposis (FAP). He was referred to our institution, where he underwent a computed tomography examination and endoscopy of the small intestine. The pathological diagnosis was adenocarcinoma. No invasive or metastatic lesions were observed. Therefore, partial resection of the ileum with lymphadenectomy and reconstruction of the ileostomy were performed. Pathological examination revealed that the tumor was type 2, pT3 (SS) , pN1, pPM0, pDM0, pRM0, INFb, ly1, v1, pEX0, PN0. Twenty-nine days after the surgery, the patient was diagnosed with lung metastasis and he underwent lung radiofrequency ablation. We suggest that long-term follow-up is necessary for patients after surgery for FAP, because of the risk of malignant disease developing in other organs.

DOI： 10.4044/joma.129.111

POEM (Per-Oral Endoscopic Myotomy) を施行した食道アカラシアの1例

杉原雄策, 原田馨太, 加藤諒, 山内健司, 高嶋志保, 竹井大介, 井口俊博, 高原政宏, 川野誠司, 平岡佐規子, 田辺俊介, 野間和宏, 白川靖博, 眞部紀明, 井上晴洋, 岡田裕之

岡山医学会雑誌 129 ( 2 ) 115 - 121 2017年

記述言語：日本語出版者・発行元：岡山医学会

&emsp;Esophageal achalasia is a disorder of the lower esophageal sphincter muscle. Patients present with dysphagia, chest pain, vomiting, and aspiration. Esophageal achalasia had traditionally been treated with esophageal achalasia balloon dilatation and the Heller-Dor method, but in recent years, the use of per-oral endoscopic myotomy (POEM) has increased. Our patient, a 39-yr-old male, began experiencing dysphagia 4 years prior to his referral to our hospital. Based on the results of esophagogastroduodenoscopy, esophageal radiography and high-resolution manometry, we made the diagnosis of esophageal achalasia (Chicago classification type I) . After informed consent from the patient and his family and approval from our hospital's ethics committee were obtained, we performed a POEM. The patient was discharged on the 4th day post-surgery. At the 1-year post-operative examination, no worsening of symptoms and no relapse were observed. POEM is an excellent treatment method for esophageal achalasia from the perspective of therapeutic effect and prevention of invasion. We recommend that it be considered as the first-choice treatment for achalasia. However, accessibility to the procedure itself is limited due to the few adequately trained operators worldwide. POEM should thus be performed by an expert operator at a high-volume center.

DOI： 10.4044/joma.129.115

その他リンク： http://search.jamas.or.jp/link/ui/2017339773

Consecutive Measurements by Faecal Immunochemical Test in Quiescent Ulcerative Colitis Patients Can Detect Clinical Relapse 査読国際誌

Sakiko Hiraoka, Jun Kato, Asuka Nakarai, Shiho Takashima, Toshihiro Inokuchi, Daisuke Takei, Yuusaku Sugihara, Masahiro Takahara, Keita Harada, Hiroyuki Okada

JOURNAL OF CROHNS & COLITIS 10 ( 6 ) 687 - 694 2016年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：OXFORD UNIV PRESS

We have reported that results of the quantitative faecal immunochemical test (FIT; haemoglobin concentrations in faeces measured using an antibody for human haemoglobin) effectively reflect the mucosal status of ulcerative colitis (UC). The aim of this study was to evaluate the predictability of flare-up in quiescent UC patients by consecutive FIT evaluation.
Patients with UC who fulfilled the following criteria by index colonoscopy were enrolled: clinical remission; mucosal healing (Mayo endoscopic subscore 0); and negative FIT (less than 100ng/mL). These patients were followed up prospectively every 1-3 months by monitoring patient symptoms and FIT results between index and subsequent colonoscopies.
The intervals between 2 colonoscopies (median 2.51 years) of 83 patients (49 males, median age at onset 34 years, median disease duration 9.74 years) were analysed. None of the 43 (52%) patients who maintained negative FIT throughout the observation period exhibited clinical relapse. On the other hand, 25/40 (63%) patients who showed positive conversion of FIT during the period experienced relapse. The cutoff FIT value of 450ng/mL could predict relapse with 73% positive predictive value and 96% negative predictive value. Moreover, positive conversion of FIT preceded occurrence of symptoms by 1 month or more in nearly one-third of patients with relapse.
Consecutive measurements of FIT in quiescent UC patients who achieved mucosal healing with negative FIT would help identify patients with clinical relapse whose symptoms had not yet presented. Further investigations are required for more precise prediction of relapse with this modality.

DOI： 10.1093/ecco-jcc/jjw025

Ulcerative colitis patients in clinical remission demonstrate correlations between fecal immunochemical test results, mucosal healing, and risk of relapse 査読国際誌

Asuka Nakarai, Jun Kato, Sakiko Hiraoka, Shiho Takashima, Daisuke Takei, Toshihiro Inokuchi, Yuusaku Sugihara, Masahiro Takahara, Keita Harada, Hiroyuki Okada

WORLD JOURNAL OF GASTROENTEROLOGY 22 ( 21 ) 5079 - 5087 2016年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：BAISHIDENG PUBLISHING GROUP INC

AIM: To assess the risk of relapse in ulcerative colitis (UC) patients in clinical remission using mucosal status and fecal immunochemical test (FIT) results.
METHODS: The clinical outcomes of 194 UC patients in clinical remission who underwent colonoscopy were based on evaluations of Mayo endoscopic subscores (MESs) and FIT results.
RESULTS: Patients with an MES of 0 (n = 94, 48%) showed a ten-fold lower risk of relapse than those with an MES of 1-3 (n = 100, 52%) (HR = 0.10, 95%CI: 0.05-0.19). A negative FIT result (fecal hemoglobin concentrations <= 100 ng/mL) was predictive of patients with an MES of 0, with a sensitivity of 0.94 and a specific of 0.76. Moreover, patients with a negative FIT score had a six-fold lower risk of clinical relapse than those with a positive score (HR = 0.17, 95%CI: 0.10-0.28). Inclusion of the distinguishing parameter, sustaining clinical remission > 12 mo, resulted in an even stronger correlation between negative FIT results and an MES of 0 with respect to the risk of clinical relapse (HR = 0.11, 95%CI: 0.04-0.23).
CONCLUSION: Negative FIT results one year or more after remission induction correlate with complete mucosal healing (MES 0) and better prognosis. Performing FIT one year after remission induction may be useful for evaluating relapse risk.

DOI： 10.3748/wjg.v22.i21.5079

Fecal Immunochemical Test Versus Fecal Calprotectin for Prediction of Mucosal Healing in Crohn's Disease 査読国際誌

Toshihiro Inokuchi, Jun Kato, Sakiko Hiraoka, Shiho Takashima, Asuka Nakarai, Daisuke Takei, Yuusaku Sugihara, Masahiro Takahara, Seiji Kawano, Keita Harada, Hiroyuki Okada

INFLAMMATORY BOWEL DISEASES 22 ( 5 ) 1078 - 1085 2016年5月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

Background: Mucosal healing (MH) has been proposed as a treatment goal of inflammatory bowel disease patients. We reported recently that not only fecal calprotectin (Fcal) but also the fecal immunochemical test (FIT) can predict MH in ulcerative colitis. However, the predictive power of the fecal markers for MH in Crohn's disease (CD), particularly with small bowel lesions, has not been reported in detail. The aim of this study was to evaluate the predictability of FIT versus Fcal for MH in CD.
Methods: Consecutive CD patients underwent colonoscopy or balloon-assisted enteroscopy according to the disease location. FIT and Fcal were examined using stool samples collected the day before endoscopy.
Results: Seventy-one CD patients were analyzed, of whom 42 (59%) underwent balloon-assisted enteroscopy because of the presence of affected lesions in the small intestine. Both the Fcal and the FIT results were significantly correlated with endoscopic activity (r = 0.67 and 0.54, respectively). However, the FIT results did not correlate with the activity in patients with small bowel lesions alone, whereas Fcal did (r = 0.42 versus 0.78). Fcal predicted MH in CD with 87% sensitivity and 71% specificity, whereas the values for FIT were 96% and 48%, respectively. The specificity for MH among patients with small bowel lesions alone was low for FIT (40%) compared with Fcal (80%).
Conclusions: Both FIT and Fcal were correlated with the mucosal status of CD. However, the specificity of FIT was not satisfactory, particularly for small bowel lesions.

DOI： 10.1097/MIB.0000000000000728

【IBD治療のcritical point-私ならこうする】潰瘍性大腸炎ステロイド依存性の見極めと治療方針チオプリン製剤による寛解維持療法

井口俊博, 平岡佐規子, 高嶋志保, 半井明日香, 高原政宏, 岡田裕之

臨床消化器内科 31 ( 6 ) 655 - 659 2016年5月

記述言語：日本語出版者・発行元：(株)日本メディカルセンター

チオプリン製剤は潰瘍性大腸炎においてステロイド依存例に対するステロイド減量効果,および寛解維持効果を有する貴重な薬剤である.活性体である6-TGN(6-thioguanine nucleotide)に変換され安定して薬効を発揮するまでに時間が必要であり,しばしば副作用を伴うことから使用に当たり習熟が不可欠である.しかし投与開始後から慎重にモニタリングを行うことで対応可能であり,その有効性,利便性,医療経済の観点から抗TNFα抗体製剤に優先してチオプリン製剤を活用すべきである.(著者抄録)

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01937&link_issn=&doc_id=20160530220007&doc_link_id=10.19020%2FJ01937.2016299263&url=https%3A%2F%2Fdoi.org%2F10.19020%2FJ01937.2016299263&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

EMR手技のスキルアップを目指してスネア先端を用いたprecutting EMRのススメ

原田馨太, 高嶋志保, 竹井大介, 井口俊博, 半井明日香, 杉原雄策, 高原政宏, 平岡佐規子, 河原祥朗, 岡田裕之

日本大腸検査学会雑誌 32 ( 2 ) 127 - 127 2016年3月

同種造血幹細胞移植施行後GVHD症例の重症度・治療反応性は、回腸末端の内視鏡所見より予測できるか?

杉原雄策, 平岡佐規子, 高嶋志保, 竹井大介, 半井明日香, 高原政宏, 原田馨太, 岡田裕之, 山本和秀, 田中健大

Gastroenterological Endoscopy 57 ( Suppl.2 ) 2132 - 2132 2015年9月

Evaluation of Mucosal Healing in Ulcerative Colitis by Fecal Calprotectin Vs. Fecal Immunochemical Test 査読国際誌

Shiho Takashima, Jun Kato, Sakiko Hiraoka, Asuka Nakarai, Daisuke Takei, Toshihiro Inokuchi, Yuusaku Sugihara, Masahiro Takahara, Keita Harada, Hiroyuki Okada, Takehiro Tanaka, Kazuhide Yamamoto

AMERICAN JOURNAL OF GASTROENTEROLOGY 110 ( 6 ) 873 - 880 2015年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：NATURE PUBLISHING GROUP

OBJECTIVES: We previously showed that a quantitative fecal immunochemical test (FIT) can predict mucosal healing (MH) in ulcerative colitis (UC). Fecal calprotectin (Fcal) has also been reported as an important biomarker of UC activity. The aim of this study was to compare the predictive ability of these two fecal markers for MH in UC.
METHODS: FIT and Fcal were examined in stool samples from consecutive UC patients who underwent colonoscopy. Mucosal status was assessed via the Mayo endoscopic subscore (MES).
RESULTS: In total, 105 colonoscopies in 92 UC patients were evaluated in conjunction with the FIT and Fcal results. Both FIT and Fcal results were significantly correlated with MES (Spearman's rank correlation coefficient: 0.61 and 0.58, respectively). The sensitivity and specificity of the FIT values (<100 ng/ml) for predicting MH (MES 0 alone) were 0.95 and 0.62, respectively, whereas those of Fcal (<250 mu g/g) were 0.82 and 0.62, respectively. The sensitivities became similar when MH was defined as MES 0 or 1 (0.86 vs. 0.86). Although the predictability of MH evaluated by the area under the receiver operating characteristics curve was similar for the two fecal markers (FIT 0.83 vs. Fcal 0.82 for MES 0 alone), the FIT results were relatively robust regardless of the cutoff value selected.
CONCLUSIONS: Both FIT and Fcal can efficiently predict MH in UC, but FIT appears to be more sensitive than Fcal for predicting MES 0 alone.

DOI： 10.1038/ajg.2015.66

TNFAIP3 promotes survival of CD4 T cells by restricting MTOR and promoting autophagy. 査読国際誌

Yu Matsuzawa, Shigeru Oshima, Masahiro Takahara, Chiaki Maeyashiki, Yasuhiro Nemoto, Masanori Kobayashi, Yoichi Nibe, Kengo Nozaki, Takashi Nagaishi, Ryuichi Okamoto, Kiichiro Tsuchiya, Tetsuya Nakamura, Averil Ma, Mamoru Watanabe

Autophagy 11 ( 7 ) 1052 - 1062 2015年6月

直腸肛門部腫瘍の術後吻合部狭窄に対する、内視鏡的新規治療RIC法応用の試み

原田馨太, 岡田裕之, 高嶋志保, 竹井大介, 井口俊博, 半井明日香, 杉原雄策, 高原政宏, 川野誠司, 平岡佐規子, 河原祥朗, 近藤喜太, 山本和秀

Gastroenterological Endoscopy 57 ( Suppl.1 ) 927 - 927 2015年4月

内視鏡的粘膜下層剥離術(ESD)が施行された大腸T1(SM)癌の治療成績と予後の検討

榮浩行, 原田馨太, 浦岡俊夫, 高嶋志保, 井口俊博, 竹井大介, 杉原雄策, 半井明日香, 高原政宏, 小林沙代, 高橋索真, 齊藤俊介, 堀井城一朗, 東玲治, 平岡佐規子, 岡田裕之, 山本和秀

Gastroenterological Endoscopy 57 ( Suppl.1 ) 804 - 804 2015年4月

潰瘍性大腸炎患者における大腸腫瘍性病変の内視鏡治療当院の現況

原田馨太, 平岡佐規子, 高嶋志保, 竹井大介, 井口俊博, 半井明日香, 杉原雄策, 高原政宏, 衣笠秀明, 川野誠司, 河原祥朗, 岡田裕之, 山本和秀

日本消化器病学会雑誌 112 ( 臨増総会 ) A496 - A496 2015年3月

IL-7 promotes long-term in vitro survival of unique long-lived memory subset generated from mucosal effector memory CD4+ T cells in chronic colitis mice. 査読国際誌

Masahiro Takahara, Yasuhiro Nemoto, Shigeru Oshima, Yu Matsuzawa, Takanori Kanai, Ryuichi Okamoto, Kiichiro Tsuchiya, Tetsuya Nakamura, Kazuhide Yamamoto, Mamoru Watanabe

Immunol. Lett. 156 ( 1-2 ) 82 - 93 2013年11月

Bone marrow-mesenchymal stem cells are a major source of interleukin-7 and sustain colitis by forming the niche for colitogenic CD4 memory T cells 査読国際誌

Yasuhiro Nemoto, Takanori Kanai, Masahiro Takahara, Shigeru Oshima, Tetsuya Nakamura, Ryuichi Okamoto, Kiichiro Tsuchiya, Mamoru Watanabe

GUT 62 ( 8 ) 1142 - 1152 2013年8月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：BMJ PUBLISHING GROUP

Objective
Interleukin (IL)-7 is mainly produced in bone marrow (BM) that forms the niche for B cells. We previously demonstrated that BM also retains pathogenic memory CD4 T cells in murine models of inflammatory bowel disease (IBD). However, it remains unknown whether BM-derived IL-7 is sufficient for the development of IBD and which cells form the niche for colitogenic memory CD4 T cells in BM.
Design
To address these questions, we developed mice in which IL-7 expression was specific for BM, and identified colitis-associated IL-7-expressing mesenchymal stem cells (MSC) in the BM.
Results
IL-7(-/-)xRAG-1(-/-) mice injected with BM cells from IL-7(+/+)xRAG-1(-/-) mice, but not from IL-7(-/-)xRAG-1(-/-) mice, expressed IL-7 in BM, but not in their colon, and developed colitis when injected with CD4(+)CD45RB(high) T cells. Cultured BM MSC stably expressed a higher level of IL-7 than that of primary BM cells. IL-7-sufficient, but not IL-7-deficient, BM MSC supported upregulation of Bcl-2 in, and homeostatic proliferation of, colitogenic memory CD4 T cells in vitro. Notably, IL-7(-/-)xRAG-1(-/-) mice transplanted with IL-7-sufficient, but not IL-7-deficient, BM MSC expressed IL-7 in BM, but not in their colon, and developed colitis when transplanted with CD4(+)CD45RB(high) T cells.
Conclusions
We demonstrate for the first time that BM MSC are a major source of IL-7 and play a pathological role in IBD by forming the niche for colitogenic CD4 memory T cells in BM.

DOI： 10.1136/gutjnl-2012-302029

Th1/Th17-Mediated Interstitial Pneumonia in Chronic Colitis Mice Independent of Intestinal Microbiota 査読

Yasuhiro Nemoto, Takanori Kanai, Masahiro Takahara, Shigeru Oshima, Ryuichi Okamoto, Kiichiro Tsuchiya, Satoshi Matsumoto, Mamoru Watanabe

JOURNAL OF IMMUNOLOGY 190 ( 12 ) 6616 - 6625 2013年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：AMER ASSOC IMMUNOLOGISTS

Although intestinal microbiota are essential for the development of T cell-mediated colitis, it remains undetermined whether they enhance or suppress the chronic extraintestinal inflammation that often complicates inflammatory bowel diseases. In this study, we investigate the role of intestinal microbiota in the development of colitis and extraintestinal manifestations in a mouse model in which colitis was induced in SCID mice by adoptive transfer of CD4(+) CD45RB(high) T cells. Under specific pathogen-free conditions, these mice developed both colitis and extraintestinal interstitial pneumonia, whereas mice given a mixture of antibiotics did not develop colitis, but, surprisingly, developed Th1/Th17-mediated IP. Irrespective of antibiotic treatment, cotransfer of CD4(+) CD25(+) regulatory T cells suppressed the development of pneumonitis and colitis, with all local CD4(+) CD45RB(high) T cell-derived cells converted to CD44(high) CD62L(-) IL-7R alpha(high) effector-memory T cells. Retransfer of CD4(+) effector-memory T cells from the lungs of antibiotic-treated mice with IP not only induced IP in both antibiotic-treated and -untreated recipients but also induced colitis in the untreated recipients. In summary, we have established a unique model of Th1/Th17-mediated IP in microbiota-free and antibiotic-treated mice. This model may be valuable in investigating the immunological mechanisms underlying extraintestinal disorders in patients with inflammatory bowel disease.

DOI： 10.4049/jimmunol.1202930

Peppermint Oil Solution Is Useful as an Antispasmodic Drug for Esophagogastroduodenoscopy, Especially for Elderly Patients 査読国際誌

Atsushi Imagawa, Hidenori Hata, Morihito Nakatsu, Yasunari Yoshida, Keiko Takeuchi, Toshihiro Inokuchi, Takayuki Imada, Yoshiyasu Kohno, Masahiro Takahara, Kazuyuki Matsumoto, Hirokazu Miyatake, Satoru Yagi, Masaharu Ando, Mamoru Hirohata, Shigeatsu Fujiki, Ryuta Takenaka

DIGESTIVE DISEASES AND SCIENCES 57 ( 9 ) 2379 - 2384 2012年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：SPRINGER

Although hyoscine butyl bromide (HB) and glucagon (GL) are often used as antispasmodic drugs during esophagogastroduodenoscopy (EGD), these agents may cause adverse effects. Recently, it was reported that peppermint oil solution (PO) was very effective and had few side effects.
We clarified the efficacy and usefulness of PO as an antispasmodic during upper endoscopy, especially for elderly patients.
This study was a non-randomized prospective study. The antispasmodic score (1-5, where 5 represents no spasm) was defined according to the degree of spasms of the antrum and difficulty of biopsy. We compared the antispasmodic scores between non-elderly patients (younger than 70) and elderly patients (70 years old or older) according to the antispasmodic agent.
A total of 8,269 (Group PO: HB: GL: NO (no antispasmodic) = 1,893: 6,063: 157: 156) EGD procedures were performed. There was no significant difference in the antispasmodic score between Group PO (mean score +/- A standard deviation: 4.025 +/- A 0.925) and Group HB (4.063 +/- A 0.887). Among the non-elderly patients, those in Group PO (n = 599, 3.923 +/- A 0.935) had a worse antispasmodic score than those in Group HB (n = 4,583, 4.062 +/- A 0.876, P < 0.001). However, among the elderly patients, those in Group PO (n = 1,294, 4.073 +/- A 0.917) had similar scores to those in Group HB (n = 1,480, 4.064 +/- A 0.921, P = 0.83), and significantly better scores than those in Group GL (n = 69, 3.797 +/- A 0.933, P < 0.05).
Peppermint oil was useful as an antispasmodic during EGD, especially for elderly patients.

DOI： 10.1007/s10620-012-2194-4

Partial Splenic Embolization Facilitates the Adherence to Peginterferon in Chronic Hepatitis C with Thrombocytopenia 査読

Masahiro Takahara, Yasuhiro Miyake, Hirokazu Miyatake, Atsushi Imagawa, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata, Kazuhide Yamamoto

INTERNAL MEDICINE 50 ( 22 ) 2731 - 2736 2011年

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：JAPAN SOC INTERNAL MEDICINE

Objective Platelet counts before starting the treatment affect the discontinuation and dose reduction of peginterferon in chronic hepatitis C. Thrombocytopenia leads to failure to achieve sustained virological response. This study was undertaken to evaluate the efficacy of partial splenic embolization (PSE) prior to starting peginterferon therapy combined with ribavirin in chronic hepatitis C patients showing thrombocytopenia.
Patients and Methods We compared the clinical features of 11 patients receiving PSE (PSE group) prior to starting the combined therapy with those of 13 patients not receiving PSE (non-PSE group). All of the patients showed platelet counts <= 12x10(4)/mm(3) and serum hepatitis C virus-RNA levels >= 100 KIU/mL at baseline. The end-point of PSE was a volume of splenic infarction over 75%. Peginterferon alpha-2b at a dose of 1.2 mu g/kg was administered by subcutaneous injection once a week. The dose of ribavirin was weight adjusted.
Results PSE was successfully performed without serious adverse events. The period from PSE to starting the combined therapy was 14 (6-27) days. After PSE, platelet counts were significantly increased. In PSE group, platelet counts during the combined therapy were maintained above those at baseline. In non-PSE group, platelet counts at the 2nd week after the start of the combined therapy significantly decreased to less than those at baseline. Overall, 80% adherence to expected peginterferon dose was not achieved in 5 patients (45%) of PSE group and in 11 (85%) of non-PSE group (p=0.043).
Conclusion Increased platelet counts after PSE facilitates the adherence to peginterferon therapy in chronic hepatitis C patients with thrombocytopenia.

DOI： 10.2169/internalmedicine.50.6143

Large Waist Circumference Is a Risk Factor for Reflux Esophagitis in Japanese Males 査読国際誌

Hisae Yasuhara, Yasuhiro Miyake, Tatsuya Toyokawa, Kazuyuki Matsumoto, Masahiro Takahara, Takayuki Imada, Satoru Yagi, Hirokazu Miyatake, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata

DIGESTION 81 ( 3 ) 181 - 187 2010年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：KARGER

Background/Aims: The prevalence of reflux esophagitis, which might lead to development of Barrett's esophagus and esophageal adenocarcinoma, has been increasing. The aim of this study was to assess risk factors for reflux esophagitis. Methods: We conducted a cross-sectional study of 1,495 Japanese subjects undergoing health checkups (822 males and 673 females; median age 50 years) at a tertiary care center. Results: One hundred and twenty-seven subjects (8%) had reflux esophagitis and hiatal hernia was observed in 292 subjects (20%). Reflux esophagitis (13 vs. 3%) and hiatal hernia (28 vs. 9%) were more frequent in males than females. Significant differences in clinical backgrounds were observed between females and males. Multivariate logistic regression analyses revealed that hiatal hernia (OR 6.63, 95% CI 2.47-17.8; p = 0.0002) was associated with reflux esophagitis in females. In males, age (per 1-year increment: OR 0.96, 95% CI 0.94-0.99; p = 0.007), hiatal hernia (OR 3.16, 95% CI 2.05-4.87; p < 0.0001) and waist circumference (per 1-cm increase: OR 1.09, 95% CI 1.02-1.15; p = 0.006) were associated with reflux esophagitis. Conclusions: Abdominal obesity may be an important risk factor for reflux esophagitis in males compared with females. Copyright (C) 2010 S. Karger AG, Basel

DOI： 10.1159/000235919

当院における胆嚢癌のまとめ

高原政宏, 豊川達也, 松本和幸, 今田貴之, 八木覚, 宮武宏和, 中津守人, 安東正晴, 廣畑衛

日本消化器病学会雑誌 106 ( 臨増大会 ) A910 - A910 2009年9月

H.pylori除菌療法は萎縮粘膜を改善し、特に萎縮の進んだ症例では早期に改善する長期間のprospective cohort studyの結果から

豊川達也, 高原政宏, 松本和幸, 今田貴之, 八木覚, 中津守人, 安東正晴

日本消化器病学会雑誌 106 ( 臨増大会 ) A771 - A771 2009年9月

A case of hepatic angiomyolipoma difficult to distinguish from hepatocellular carcinoma 査読国際誌

Masahiro Takahara, Yasuhiro Miyake, Kazuyuki Matsumoto, Daisuke Kawai, Eisuke Kaji, Tatsuya Toyokawa, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata

WORLD JOURNAL OF GASTROENTEROLOGY 15 ( 23 ) 2930 - 2932 2009年6月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：W J G PRESS

We report a case of hepatic angiomyolipoma with uncommon clinical features. A 56-year-old man presented with a hepatic tumor in the caudate lobe. The tumor was hypoechoic on ultrasonography, showed early-phase hyperattenuation on enhanced computed tomography and did not absorb iron on superparamagnetic iron oxide-enhanced magnetic resonance imaging. Hepatocellular carcinoma was highly suspected, and the patient underwent hepatic resection. Histologically, the tumor was mainly composed of smooth muscle cells and contained small amounts of adipose cells and blood vessels. On immunohistochemical staining, the smooth muscle cells were positive for a melanocytic cell-specific monoclonal antibody. In cases with uncommon features of angiomyolipoma, it is quite difficult to distinguish angiomyolipoma from hepatocellular carcinoma. (C) 2009 The WJG Press and Baishideng. All rights reserved.

DOI： 10.3748/wjg.15.2930

当院における食道癌化学放射線療法の検討

松本和幸, 豊川達也, 高原政宏, 今田貴之, 八木覚, 宮武宏和, 中津守人, 安東正晴, 廣畑衛

香川県内科医会誌 45 36 - 40 2009年6月

記述言語：日本語出版者・発行元：香川県内科医会

2000年1月から2007年12月までに当院にて治療をした食道癌患者44例を対象とし、化学放射線療法(chemoradiotherapy:CRT)を施行した26例(CRT群)ならびに手術療法を施行した18例(手術群)に層別化しretrospectiveに比較検討した。年齢は45歳から86歳で中央値69歳であった。患者背景として、年齢、腫瘍占拠部位、臨床病期、PSを比較した結果、手術群で臨床病期が早期であった(p<0.01)。CRT群の奏効率は73%であり、CRT群の生存期間は2年生存率38%、4年生存率25%であった。また、根治術可能な臨床病期0〜IIIまででCRT群と手術群の生存期間を比較した結果、2年生存率はCRT群で46%、手術群で53%であり、両群間の生存期間に差異は認めなかった。食道癌に対するCRTは手術療法と比較し遜色ない治療法であった。(著者抄録)

当院におけるGIST症例の検討

河野吉泰, 豊川達也, 松本和幸, 高原政宏, 今田貴之, 八木覚, 宮武宏和, 中津守人, 安東正晴, 廣畑衛

香川県内科医会誌 45 47 - 52 2009年6月

記述言語：日本語出版者・発行元：香川県内科医会

Gastrointestinal stromal tumor(以下GIST)は全消化管切除腫瘍の0.5〜1.0%程度を占める稀な腫瘍である。今回我々は当院において病理組織学的にGISTと診断された19例を対象とし、その臨床的および病理学的特徴について検討した。発生部位は胃が14例と最多で、全体的に無症状で発見される例が多かった。手術標本の病理組織で診断されたものが13例と大部分を占めていた。腫瘍の大きさ・核分裂指数により評価した臨床的悪性度に基づきリスク分類を行った。転移・再発に関しては全て高リスク例であり、よく相関していた。予後に関しては、高リスク6例のうち死亡転帰は2例であり、リスク分類のみで予後を推測することは困難であった。予後不良因子として腹膜病変が示唆された。術前・術後化学療法の有効性や術後の適切な経過観察期間など、GISTに関して未だに臨床研究段階の項目は多く、今後さらなる症例数の集積が望まれる。(著者抄録)

ALK陰性直腸原発anaplastic large cell lymphomaの1例

高原政宏, 豊川達也, 脇正人, 小西順, 松本和幸, 今田貴之, 八木覚, 宮武宏和, 中津守人, 安東正晴, 廣畑衛

Gastroenterological Endoscopy 51 ( Suppl.1 ) 947 - 947 2009年4月

A combination treatment of entecavir and early-phase corticosteroid in severe exacerbation of chronic hepatitis B 査読国際誌

Kazuyuki Matsumoto, Yasuhiro Miyake, Hirokazu Miyatake, Masahiro Takahara, Takayuki Imada, Satoru Yagi, Tatsuya Toyokawa, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata

WORLD JOURNAL OF GASTROENTEROLOGY 15 ( 13 ) 1650 - 1652 2009年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：W J G PRESS

Of patients with severe exacerbation of chronic hepatitis B accompanied by jaundice and coagulopathy, 20%-30% have a fatal outcome. In this report, we describe 2 cases of severe exacerbation of chronic hepatitis B with jaundice and coagulopathy who were successfully treated with a combination of entecavir and corticosteroid. In both cases, rapid reductions in serum hepatitis B virus (HBV)-DNA levels were observed, and corticosteroid was stopped after serum HBV-DNA levels became undetectable. Entecavir treatment was continued. Generally, entecavir treatment reduced serum HBV-DNA levels rapidly, although the improvement in liver function was delayed by a few weeks. During this time lag, liver cell injury continued and the disease progressed. Corticosteroid suppressed the excessive host immune response and was useful for stopping progressive deterioration. A combination of entecavir and early-phase corticosteroid may be a useful treatment in severe exacerbation of chronic hepatitis B. (C) 2009 The WJG Press and Baishideng. All rights reserved.

DOI： 10.3748/wjg.15.1650

血小板低下を伴うC型慢性肝炎患者における部分的脾動脈塞栓術(PSE)はリバビリン(RBV)併用インターフェロン(IFN)治療効果を改善するか?

高原政宏, 三宅康広, 宮武宏和, 松本和幸, 今田貴之, 八木覚, 豊川達也, 中津守人, 安東正晴, 廣畑衛

肝臓 50 ( Suppl.1 ) A274 - A274 2009年4月

胃MALTリンパ腫の長期経過治療後早期にT細胞リンパ腫を発症し予後不良であった症例報告も含めて

豊川達也, 今田貴之, 中津守人, 高原政宏, 松本和幸, 八木覚, 宮武宏和, 安東正晴

Gastroenterological Endoscopy 51 ( Suppl.1 ) 899 - 899 2009年4月

当院における切除不能・再発胃がん症例に対するS-1+CDDP併用療法の検討

今田貴之, 豊川達也, 篠井尚子, 恒光美穂, 三宅智子, 河野吉泰, 中野由加里, 氏家はる代, 竹内洋平, 小西順, 堀元直哉, 松本和幸, 高原政宏, 八木覚, 宮武宏和, 中津守人, 安東正晴

日本消化器病学会雑誌 106 ( 臨増総会 ) A178 - A178 2009年3月

当院における食道癌化学放射線治療の検討

松本和幸, 豊川達也, 河野吉泰, 氏家はる代, 中野由加里, 小西順, 高原政宏, 今田貴之, 八木覚, 宮武宏和, 中津守人, 安東正晴, 広畑衛

日本消化器病学会雑誌 106 ( 臨増総会 ) A185 - A185 2009年3月

当院における小腸(十二指腸を含む)腫瘍性疾患の検討

安原ひさ恵, 豊川達也, 高原政宏, 松本和幸, 今田貴之, 八木覚, 宮武宏和, 中津守人, 安東正晴

日本消化器病学会雑誌 106 ( 臨増総会 ) A319 - A319 2009年3月

当院におけるGIST症例の検討

河野吉泰, 豊川達也, 松本和幸, 高原政宏, 今田貴之, 八木覚, 宮武宏和, 中津守人, 安東正晴

日本消化器病学会雑誌 106 ( 臨増総会 ) A325 - A325 2009年3月

B型慢性肝炎急性増悪重症例に対しエンテカビルとステロイドを併用し奏効した2例

宮武宏和, 三宅康広, 松本和幸, 河野吉泰, 竹内洋平, 氏家はる代, 中野由加理, 小西順, 高原政宏, 今田貴之, 八木覚, 豊川達也, 中津守人, 安東正晴, 廣畑衛

日本消化器病学会雑誌 106 ( 臨増総会 ) A465 - A465 2009年3月

腹部超音波検査にて経過観察しえた上腸間膜動脈症候群の一例

宮武宏和, 豊川達也, 松本和幸, 今田貴之, 竹内洋平, 森本尚孝, 高原政宏, 八木覚, 中津守人, 安東正晴

超音波医学 36 ( 1 ) 103 - 103 2009年1月

A case of primary malignant lymphoma of the liver treated by R-CHOP therapy 査読

Akinori Asagi, Yasuhiro Miyake, Masaharu Ando, Hisae Yasuhara, Kazuyuki Matsumoto, Masahiro Takahara, Daisuke Kawai, Eisuke Kaji, Tatsuya Toyokawa, Toru Onishi, Katsuya Miyatani, Morihito Nakatsu

Journal of Japanese Society of Gastroenterology 106 ( 3 ) 389 - 396 2009年

記述言語：日本語掲載種別：研究論文（学術雑誌）

A 75-year-old man was admitted to our hospital because of right hypochondralgia. Computed tomography (CT) revealed a large tumor in the right lobe of the liver. Ultrasonography (US) showed vessels in the tumor. Needle biopsy specimens showed malignant lymphoma (Diffuse large B cell lymphoma). Ga scintigraphy and FDG-PET did not demonstrate other lesions and the definitive diagnosis was primary malignant lymphoma of the liver. CHOP with Rituximab therapy (R-CHOP therapy) was performed. After 8 courses of therapy the FDG-PET results were negative and we considered complete remission. We describe a case of primary malignant lymphoma of the liver treated successfully by R-CHOP therapy.

インジゴカルミン入りガストログラフィン注腸が診断に有用であったS状結腸膀胱瘻の1例

高原政宏, 豊川達也, 小西順, 安原ひさ恵, 松本和幸, 河合大介, 加地英輔, 三宅康広, 中津守人, 安東正晴, 廣畑衛, 水田稔, 宮谷克也

三豊総合病院雑誌 29 68 - 72 2008年12月

記述言語：日本語出版者・発行元：三豊総合病院

77歳男。全身倦怠感と発熱を主訴とした。血液検査で炎症反応の上昇、尿検査で膿尿を認め、CTで膀胱内にairと大腸に多発する憩室を認めた。結腸膀胱瘻による有熱性尿路感染を疑い、瘻孔を確認するために膀胱鏡、膀胱造影、大腸内視鏡検査、注腸造影を施行したが、瘻孔は確認できなかった。しかし、注腸検査時に工夫を凝らし、インジゴカルミンを混ぜたガストログラフィンを用いて検査を行ったところ、尿道バルーン内にインジゴカルミンの流出を認め、その直後行ったCTでも膀胱内にガストログラフィンの充満を認め、瘻孔の存在を確認できた。結腸膀胱瘻と診断し、左側結腸切除術および膀胱部分切除術を施行した。病理組織学的所見で膀胱が付着する部位は全層にかけてリンパ球、好中球、形質細胞の炎症細胞が浸潤し、瘻孔が形成されているものと考えられた。また、周囲に憩室を認めたことから、憩室が原因と推測した。

当院におけるGIST症例の検討

河野吉泰, 豊川達也, 小西順, 松本和幸, 高原政宏, 今田貴之, 八木覚, 宮武宏和, 中津守人, 安東正晴, 廣畑衛

香川県医師会誌 61 ( 特別 ) 67 - 67 2008年10月

腸管アミロイドーシスの2症例

安原ひさ恵, 豊川達也, 小西順, 高原政宏, 松本和幸, 今田貴之, 八木覚, 三宅康広, 中津守人, 安東正晴

日本消化器病学会雑誌 105 ( 臨増大会 ) A829 - A829 2008年9月

高齢者の膵癌患者に対する低用量gemcitabine療法は有用である

松本和幸, 豊川達也, 三宅康広, 安原ひさ恵, 高原政宏, 今田貴之, 八木寛, 中津守人, 安東正晴, 廣畑衛

日本消化器病学会雑誌 105 ( 臨増大会 ) A903 - A903 2008年9月

血小板減少を伴うC型慢性肝炎症例に対する部分的脾動脈塞栓術(PSE)の有効性

高原政宏, 三宅康広, 安原ひさ恵, 松本和幸, 今田貴之, 八木覚, 豊川達也, 中津守人, 安東正晴, 廣畑衛

肝臓 49 ( Suppl.2 ) A555 - A555 2008年9月

十二指腸潰瘍に対しHelicobacter pylori除菌を行い、6年後に胃癌が発覚した1例

八木覚, 豊川達也, 安原ひさ恵, 高原政宏, 松本和幸, 今田貴之, 三宅康広, 中津守人, 安東正晴, 宮谷克也

日本消化器病学会雑誌 105 ( 臨増大会 ) A775 - A775 2008年9月

術前診断が困難であった副脾の一例

高原政宏, 豊川達也, 安原ひさ恵, 松本和幸, 河合大介, 浅木彰則, 加地英輔, 三宅康宏, 中津守人, 安東正晴, 廣畑衛

香川県内科医会誌 44 93 - 93 2008年6月

当院における低未分化大腸癌の検討

松本和幸, 豊川達也, 安原ひさ恵, 高原政宏, 河合大介, 浅木彰則, 加地英輔, 三宅康宏, 中津守人, 安東正晴, 廣畑衛

香川県内科医会誌 44 91 - 91 2008年6月

Low dose gemcitabine improves the prognosis of elderly patients with unresectable advanced pancreatic cancer 査読

Kazuyuki Matsumoto, Tatsuya Toyokawa, Yasuhiro Miyake, Hisae Yasumara, Masahiro Takahara, Eisuke Kaji, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata

GASTROENTEROLOGY 134 ( 4 ) A453 - A454 2008年4月

胃腫瘍性病変に対するESDの所要時間による検討

豊川達也, 加地英輔, 松本和幸, 高原政宏, 安原ひさ恵, 河合大介, 三宅康広, 中津守人, 安東正晴

Gastroenterological Endoscopy 50 ( Suppl.1 ) 792 - 792 2008年4月

肝細胞癌との鑑別に苦慮した肝血管筋脂肪腫の2例

高原政宏, 三宅康広, 安原ひさ恵, 松本和幸, 河合大介, 加地英輔, 豊川達也, 中津守人, 安東正晴, 廣畑衛

日本消化器病学会雑誌 105 ( 臨増総会 ) A390 - A390 2008年3月

腹腔内リンパ節転移を伴う胃MALTリンパ腫に対しR-CHOP療法が奏功した1例

河合大介, 豊川達也, 安原ひさ恵, 高原政宏, 松本和幸, 加地英輔, 三宅康広, 中津守人, 安東正晴

日本消化器病学会雑誌 105 ( 臨増総会 ) A253 - A253 2008年3月

術前診断が困難であった副脾の1例

高原政宏, 豊川達也, 松本和幸, 安原ひさ恵, 堀元直哉, 河合大介, 加地英輔, 三宅康広, 中津守人, 安東正晴, 廣畑衛, 宇高徹総, 宮谷克也

三豊総合病院雑誌 28 58 - 64 2007年12月

記述言語：日本語出版者・発行元：三豊総合病院

54歳女。患者は右下腹部痛を主訴とした。腹部造影CTでは膵尾部に単純相で膵臓と同程度の吸収値、動脈相で濃染され、平行相でやや膵よりも高い吸収値の腫瘤を認めた。造影MRIではCTで指摘された腫瘤はT1強調画像で低信号、T2強調画像でやや高信号、Gd造影で動脈性濃染を認めた。非機能性膵ラ氏島腫瘍と考え、膵尾部切除、脾臓摘出術、リンパ節生検を施行したところ、病理組織学的所見では腫瘤は線維性皮膜を有し、赤血球が充満した赤脾髄にリンパ球が集族した白脾髄がみられ、脾臓組織であった。また、リンパ節生検の免疫染色では濾胞性リンパ腫と判明、副脾内の白脾髄の腫大が目立つため免疫染色を行うと、副脾内にもリンパ腫が浸潤していた。以上、これらのことからも、本症例は膵内副脾と濾胞性リンパ腫と確定診断された。

高齢者における手術不能膵癌に対する抗腫瘍療法の検討

松本和幸, 豊川達也, 安原ひさ恵, 高原政宏, 河合大介, 加地英輔, 三宅康広, 中津守人, 安東正晴, 廣畑衛

三豊総合病院雑誌 28 3 - 7 2007年12月

記述言語：日本語出版者・発行元：三豊総合病院

手術不能膵癌について、特に高齢者における抗腫瘍療法の有用性を検討した。対象は過去約1年間に切除不能と診断された膵癌68症例のうち、75歳以上の32例で、これらを抗腫瘍療法(ACT)が施行された17例(ACT群、平均年齢80.1歳)とACTを施行しなかった15例(BCS群、平均年齢83.0歳)に分け調べた。その結果、1)BCS群はACT群に比べて有意にECOGのPerformance Status(PS)が不良であった。2)全体での検討では、ACT群はBCS群よりも生存期間の延長が認められたが、75歳以上の比較ではACT群はBCS群よりも年齢が若く、PSが良好であり、長期生命予後が望めるにもかかわらず、生存期間の延長を認めなかった。3)有害事象の発現率は、75歳以上群と75歳未満群との間に差異は認められなかったが、詳細に検討すると、75歳以上群では抗腫瘍療法を開始した後に症状が強く発現し、急速に全身状態が不良となる症例を認めており、ACT群17例中4例は80日以内と早期に死亡していた。

PSE施行後にリバビリン併用インターフェロン療法を行ったC型慢性肝炎患者10例の検討

三宅康広, 安東正晴, 高原政宏, 安原ひさ恵, 松本和幸, 河合大介, 豊川達也, 中津守人, 広畑衛

肝臓 48 ( Suppl3 ) A647 - A647 2007年11月

高齢者における手術不能膵癌に対する抗腫瘍療法の検討

松本和幸, 豊川達也, 安原ひさ恵, 高原政宏, 河合大介, 加地英輔, 三宅康広, 中津守人, 安東正晴, 廣畑衛

香川県医師会誌 60 ( 特別 ) 61 - 61 2007年10月

高齢者の上部消化管腫瘍性病変に対する内視鏡的粘膜下層剥離術(ESD)の適応と問題点

豊川達也, 加地英輔, 安原ひさ恵, 松本和幸, 高原政宏, 河合大介, 三宅康広, 中津守人, 安東正晴, 廣畑衛

香川県医師会誌 60 ( 特別 ) 62 - 62 2007年10月

PSE施行後にリバビリン併用インターフェロン療法を行ったC型慢性肝炎患者10例の検討

三宅康広, 安東正晴, 小西順, 高原政宏, 安原ひさ恵, 松本和幸, 河合大介, 加地英輔, 豊川達也, 中津守人, 廣畑衛

香川県医師会誌 60 ( 特別 ) 60 - 60 2007年10月

EWSを用いた内視鏡的lung volume reductionにて著明な改善が得られた1例

篠井尚子, 南木伸基, 山地康文, 堀元直哉, 高谷陽一, 高原政宏, 小西順

香川県医師会誌 60 ( 特別 ) 64 - 64 2007年10月

Hepatic steatosis correlates with the postoperative recurrence of hepatitis C virus-associated hepatocellular carcinoma 査読国際誌

Yoshitaka Takuma, Kazuhiro Nouso, Yasuhiro Makino, Shunsuke Saito, Hiroki Takayama, Masahiro Takahara, Hideaki Takahashi, Ichiro Murakami, Hitoshi Takeuchi

LIVER INTERNATIONAL 27 ( 5 ) 620 - 626 2007年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：BLACKWELL PUBLISHING

Background: Hepatic steatosis is a prominent feature of chronic hepatitis C. Hepatic steatosis was reported recently to be a risk factor for hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCC).
Aim: To investigate whether hepatic steatosis influences the postoperative recurrence of HCV-associated HCC.
A retrospective study was conducted in 88 patients undergoing curative resection of HCV-associated HCC. Cumulative tumour recurrence rates were compared between steatosis-positive and steatosis-negative patients, and the factors affecting intrahepatic recurrence were assessed.
Results: The respective tumour recurrence rates at 1, 3, and 5 years were 19%, 76%, and 92% in the steatosis-positive group, and 12%, 52%, and 60% in the steatosis-negative group. The tumour recurrence rate of the steatosis-positive group was significantly higher than that of the steatosis-negative group (P=0.02). Hepatic steatosis [relative risk (RR)=3.31, 95% confidence intervals (CIs)=1.49-7.41, P=0.003], stage of fibrosis (RR=3.17, 95% CI=1.35-7.47, P=0.008), surgical procedure (RR=0.22, 95% CI=0.076-0.64, P=0.005), number of tumours (RR=5.24, 95% CI=1.63-16.80, P=0.005), size of the largest tumour (RR=3.52, 95% CI=1.28-9.69, P=0.02), and vascular invasion (RR=2.72, 95% CI=1.32-5.59, P=0.007) were independent factors for tumour recurrence rate by multivariate analysis.
Conclusions: Hepatic steatosis is a useful predictor of postoperative recurrence of HCV-related HCC.

DOI： 10.1111/j.1478-3231.2007.01462.x

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