Updated on 2024/06/12

写真a

 
HIRAOKA Sakiko
 
Organization
Okayama University Hospital Associate Professor
Position
Associate Professor
External link

Degree

  • 博士 医学乙 ( 2004.5   岡山大学 )

Research Areas

  • Life Science / Gastroenterology

Professional Memberships

  • European Crohn’s and Colitis Organisation

    2018.1

  • 日本大腸肛門病学会

    2017.1

  • 日本炎症性腸疾患学会

    2017.1

  • Asian Organization for Crohn’s and Colitis

    2017.1

  • 日本内科学会

    1994.5

  • 日本消化器病学会

    1994.5

  • 日本消化器内視鏡学会

    1994.5

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Papers

  • Evidence-based clinical practice guidelines for inflammatory bowel disease 2020.

    Hiroshi Nakase, Motoi Uchino, Shinichiro Shinzaki, Minoru Matsuura, Katsuyoshi Matsuoka, Taku Kobayashi, Masayuki Saruta, Fumihito Hirai, Keisuke Hata, Sakiko Hiraoka, Motohiro Esaki, Ken Sugimoto, Toshimitsu Fuji, Kenji Watanabe, Shiro Nakamura, Nagamu Inoue, Toshiyuki Itoh, Makoto Naganuma, Tadakazu Hisamatsu, Mamoru Watanabe, Hiroto Miwa, Nobuyuki Enomoto, Tooru Shimosegawa, Kazuhiko Koike

    Journal of gastroenterology   56 ( 6 )   489 - 526   2021.6

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    Inflammatory bowel disease (IBD) is a general term for chronic or remitting/relapsing inflammatory diseases of the intestinal tract and generally refers to ulcerative colitis (UC) and Crohn's disease (CD). Since 1950, the number of patients with IBD in Japan has been increasing. The etiology of IBD remains unclear; however, recent research data indicate that the pathophysiology of IBD involves abnormalities in disease susceptibility genes, environmental factors and intestinal bacteria. The elucidation of the mechanism of IBD has facilitated therapeutic development. UC and CD display heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management depends on the understanding and tailoring of evidence-based interventions by physicians. In 2020, seventeen IBD experts of the Japanese Society of Gastroenterology revised the previous guidelines for IBD management published in 2016. This English version was produced and modified based on the existing updated guidelines in Japanese. The Clinical Questions (CQs) of the previous guidelines were completely revised and categorized as follows: Background Questions (BQs), CQs, and Future Research Questions (FRQs). The guideline was composed of a total of 69 questions: 39 BQs, 15 CQs, and 15 FRQs. The overall quality of the evidence for each CQ was determined by assessing it with reference to the Grading of Recommendations Assessment, Development and Evaluation approach, and the strength of the recommendation was determined by the Delphi consensus process. Comprehensive up-to-date guidance for on-site physicians is provided regarding indications for proceeding with the diagnosis and treatment.

    DOI: 10.1007/s00535-021-01784-1

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  • Leucine-rich alpha-2 glycoprotein as a marker of mucosal healing in inflammatory bowel disease. International journal

    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   2021.5

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    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

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  • Multicenter survey on mesalamine intolerance in patients with ulcerative colitis. International journal

    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   2021.1

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    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

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  • Liquid biopsy for patients with IBD-associated neoplasia. International journal

    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   2020.12

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    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

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  • Ulcerative Colitis Associated with a Mixed Neuroendocrine-non-neuroendocrine Neoplasm.

    Hideaki Kinugasa, Sakiko Hiraoka, Shohei Oka, Hiroyuki Okada

    Internal medicine (Tokyo, Japan)   59 ( 16 )   2085 - 2086   2020.8

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    DOI: 10.2169/internalmedicine.4609-20

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  • Blue laser imaging and linked color imaging improve the color difference value and visibility of colorectal polyps in underwater conditions. Reviewed International journal

    Yasushi Yamasaki, Keita Harada, Shumpei Yamamoto, Eriko Yasutomi, Shotaro Okanoue, Mami Hirai, Shohei Oka, Yuka Obayashi, Hiroyuki Sakae, Kenta Hamada, Toshihiro Inokuchi, Hideaki Kinugasa, Yuusaku Sugihara, Masahiro Takahara, Takehiro Tanaka, Sakiko Hiraoka, Yoshiro Kawahara, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   32 ( 5 )   791 - 800   2020.7

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    BACKGROUND AND AIM: Underwater endoscopic mucosal resection (UEMR) has become widespread for treating colorectal polyps. However, which observational mode is best suited for determining polyp margins underwater remains unclear. To determine the best mode, we analyzed three imaging modes: white light imaging (WLI), blue laser imaging (BLI) and linked color imaging (LCI). METHODS: Images of consecutive colorectal polyps previously examined by these three modes before UEMR were analyzed according to the degree of underwater turbidity (transparent or cloudy). Color differences between the polyps and their surroundings were calculated using the Commission Internationale d'Eclairage Lab color space in which 3-D color parameters were expressed. Eight evaluators, who were blinded to the histology, scored the visibility from one (undetectable) to four (easily detectable) in both underwater conditions. The color differences and visibility scores were compared. RESULTS: Seventy-three polyps were evaluated. Sixty-one polyps (44 adenomatous, 17 serrated) were observed under transparent conditions, and 12 polyps (seven adenomatous, five serrated) were observed under cloudy conditions. Under transparent conditions, color differences for the BLI (8.5) and LCI (7.9) were significantly higher than that of WLI (5.7; P < 0.001). Visibility scores for BLI (3.6) and LCI (3.4) were also higher than that of WLI (3.1; P < 0.0001). Under cloudy conditions, visibility scores for LCI (2.9) and WLI (2.7) were significantly higher than that of BLI (2.2; P < 0.0001 and P = 0.04, respectively). CONCLUSIONS: BLI and LCI were better observational modes in transparent water; however, BLI was unsuitable for cloudy conditions.

    DOI: 10.1111/den.13581

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  • 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. Reviewed International journal

    Eriko Yasutomi, Sakiko Hiraoka, Shumpei Yamamoto, Shohei Oka, Mami Hirai, Yasushi Yamasaki, Toshihiro Inokuchi, Hideaki Kinugasa, Masahiro Takahara, Keita Harada, Jun Kato, Hiroyuki Okada

    Journal of clinical medicine   8 ( 12 )   2019.12

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    BACKGROUND AND AIM: Oral mesalazine and sulfasalazine (SASP) are key drugs for treating ulcerative colitis (UC). The efficacy of switching from one of the several mesalazine formulations to another is largely unknown. This study assessed the efficacy of switching among three types of mesalazine formulation and SASP for UC therapy. METHODS: UC patients receiving high-dose mesalazine/SASP who switched to other formulations due to disease activity were considered eligible. Efficacy was evaluated 2, 6, and 12 months after switching. RESULTS: A total of 106 switches in 88 UC patients were analyzed. The efficacy at 2 months after switching was observed in 23/39 (59%) cases from any mesalazine formulation to SASP, in 18/55 (33%) cases from one mesalazine to another, and in 2/12 (17%) cases from SASP to any mesalazine formulation. Nine of 43 effective cases showed inefficacy or became intolerant post-switching. Delayed efficacy more than two months after switching was observed in four cases. Steroid-free remission was achieved in 42/106 (39%) cases-within 100 days in 35 of these cases (83%). CONCLUSIONS: Switching from mesalazine to SASP was effective in more than half of cases. The efficacy of switching between mesalazine formulations was lower but may be worth attempting in clinical practice from a safety perspective.

    DOI: 10.3390/jcm8122109

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  • Berberine improved experimental chronic colitis by regulating interferon-γ- and IL-17A-producing lamina propria CD4+ T cells through AMPK activation. Reviewed International journal

    Masahiro Takahara, Akinobu Takaki, Sakiko Hiraoka, Takuya Adachi, Yasuyuki Shimomura, Hiroshi Matsushita, Tien Thi Thuy Nguyen, Kazuko Koike, Airi Ikeda, Shiho Takashima, Yasushi Yamasaki, Toshihiro Inokuchi, Hideaki Kinugasa, Yusaku Sugihara, Keita Harada, Shingo Eikawa, Hidetoshi Morita, Heiichiro Udono, Hiroyuki Okada

    Scientific reports   9 ( 1 )   11934 - 11934   2019.8

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    The herbal medicine berberine (BBR) has been recently shown to be an AMP-activated protein kinase (AMPK) productive activator with various properties that induce anti-inflammatory responses. We investigated the effects of BBR on the mechanisms of mucosal CD4+T cell activation in vitro and on the inflammatory responses in T cell transfer mouse models of inflammatory bowel disease (IBD). We examined the favorable effects of BBR in vitro, using lamina propria (LP) CD4+ T cells in T cell transfer IBD models in which SCID mice had been injected with CD4+CD45RBhigh T cells. BBR suppressed the frequency of IFN-γ- and Il-17A-producing LP CD4+ T cells. This effect was found to be regulated by AMPK activation possibly induced by oxidative phosphorylation inhibition. We then examined the effects of BBR on the same IBD models in vivo. BBR-fed mice showed AMPK activation in the LPCD4+ T cells and an improvement of colitis. Our study newly showed that the BBR-induced AMPK activation of mucosal CD4+ T cells resulted in an improvement of IBD and underscored the importance of AMPK activity in colonic inflammation.

    DOI: 10.1038/s41598-019-48331-w

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  • Long-term outcomes of patients with Crohn's disease who received infliximab or adalimumab as the first-line biologics. Reviewed International journal

    Toshihiro Inokuchi, Sakuma Takahashi, Sakiko Hiraoka, Tatsuya Toyokawa, Shinjiro Takagi, Koji Takemoto, Jiro Miyaike, Tsuyoshi Fujimoto, Reiji Higashi, Yuki Morito, Toru Nawa, Seiyuu Suzuki, Mamoru Nishimura, Masafumi Inoue, Jun Kato, Hiroyuki Okada

    Journal of gastroenterology and hepatology   34 ( 8 )   1329 - 1336   2019.8

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    BACKGROUND AND AIM: Although previous studies compared the efficacy of infliximab (IFX) versus adalimumab (ADA) as the first-line biologics for Crohn's disease (CD), the difference in long-term prognosis based on which biologic was used first has scarcely been reported. In particular, the clinical courses after loss of response (LOR) of the first-line biologics are largely unknown. METHODS: A multicenter, retrospective study was performed. Disease courses of biologic-naïve CD patients who were started on IFX or ADA treatment were evaluated, even after LOR of the initial biologics. RESULTS: In total, 263 CD patients were eligible for analysis, 183 were treated with IFX first, and 80 were treated with ADA first. The median observation period was 64.2 months. The cumulative steroid-free remission rates and surgery-free rates did not differ significantly between the patients treated with IFX first and those treated with ADA first (log-rank test P = 0.42 and P = 0.74, respectively). In addition, no significant difference was observed in the rate of occurrence of events associated with ineffectiveness (modification of anti-tumor necrosis factor treatment including intensification, switch, discontinuation, or surgery) between the patient groups (log-rank test P = 0.62). The patients treated with IFX first were likely to discontinue the agent due to adverse events, whereas those treated with ADA first were likely to discontinue due to treatment failure or LOR. CONCLUSIONS: No significant difference was observed in the long-term prognosis between biologic-naïve patients with CD who were started treatment with IFX first and ADA first.

    DOI: 10.1111/jgh.14624

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  • Prediction of treatment outcome and relapse in inflammatory bowel disease. Reviewed International journal

    Jun Kato, Takeichi Yoshida, Sakiko Hiraoka

    Expert review of clinical immunology   15 ( 6 )   667 - 677   2019.6

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    INTRODUCTION: Prediction of treatment outcome and clinical relapse in patients with inflammatory bowel disease (IBD), either ulcerative colitis (UC) or Crohn's disease (CD), is particularly important because therapeutics for IBD are not always effective and patients in remission could frequently relapse. Because undergoing endoscopy for the purpose is sometimes invasive and burdensome to patients, the performance of surrogate biomarkers has been investigated. Areas covered: We particularly featured the performance of patient symptoms, blood markers including C-reactive protein (CRP), fecal markers including fecal calprotectin (Fcal) and fecal immunochemical test (FIT) for prediction of endoscopic mucosal healing (MH) and prediction of relapse. Studies of other modalities and therapeutic drug monitoring (TDM) have also been explored. Expert opinion: Meticulous evaluation of patient symptoms could be predictive for MH in UC. CRP and Fcal may be accurate in prediction of MH of CD when MH is evaluated throughout the entire intestine including the small bowel. Repeated measurements of fecal markers including Fcal and FIT in patients with clinical remission would raise predictability of relapse. Prediction of treatment outcome by monitoring with blood markers including CRP, fecal markers including Fcal, and TDM has frequently been performed in recent clinical trials and shown to be effective.

    DOI: 10.1080/1744666X.2019.1593140

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  • The novel latex agglutination turbidimetric immunoassay system for simultaneous measurements of calprotectin and hemoglobin in feces. Reviewed International journal

    Sakiko Hiraoka, Shiho Takashima, Toshihiro Inokuchi, Asuka Nakarai, Masahiro Takahara, Keita Harada, Yasuhiro Seki, Katsunori Watanabe, Jun Kato, Hiroyuki Okada

    Intestinal research   17 ( 2 )   202 - 209   2019.4

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    BACKGROUND/AIMS: Fecal calprotectin (Fcal) as well as the fecal immunochemical test (FIT) are useful biomarkers for detecting activity and mucosal healing in inflammatory bowel diseases. Here, we report the performance of simultaneous measurements of Fcal and FIT for ulcerative colitis (UC) patients using the newly-developed latex agglutination turbidimetric immunoassay (LATIA) system. METHODS: Fcal and hemoglobin were measured by the LATIA system in 152 UC patients who underwent colonoscopy. Fcal was also quantified with a conventional enzyme-linked immunosorbent assay (ELISA). Fecal markers were evaluated in conjunction with the mucosal status of UC, which was assessed via the Mayo endoscopic subscore (MES) classification. RESULTS: The LATIA system could quantify calprotectin and hemoglobin simultaneously with the same fecal samples within 10 minutes. The values of the Fcal-LATIA closely correlated with those of the Fcal-ELISA (Spearman rank correlation coefficient, r=0.84; P<0.0001). The values of Fcal for each assay and the FIT all significantly correlated with the MESs (Spearman rank correlation coefficient, Fcal-LATIA: r=0.58, Fcal-ELISA: r=0.55, and FIT: r=0.72). The mucosal healing predictability (determined by an MES of 0 alone) of the Fcal-LATIA, Fcal-ELISA, and FIT-LATIA with the cutoffs determined by receiver operating characteristic curve analysis was 0.79, 0.78, and 0.92 for sensitivity, respectively, and 0.78, 0.69, and 0.73 for specificity, respectively. CONCLUSIONS: The performance of the novel Fcal-LATIA was equivalent to that of the conventional Fcal assay. Simultaneous measurements with FITs would promote the clinical relevance of fecal biomarkers in UC.

    DOI: 10.5217/ir.2018.00086

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  • Feasibility of Underwater Clip Closure for Large Mucosal Defects after Colorectal Endoscopic Submucosal Dissection. Reviewed International journal

    Yasushi Yamasaki, Keita Harada, Shohei Oka, Shiho Takashima, Toshihiro Inokuchi, Yuusaku Sugihara, Masahiro Takahara, Sakiko Hiraoka, Hiroyuki Okada

    Digestion   99 ( 4 )   327 - 332   2019

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    BACKGROUND/AIMS: Clip closure of mucosal defects after colorectal endoscopic submucosal dissection (C-ESD) may decrease the incidence of delayed adverse events. The size of the defect to be closed by conventional clip is limited, however, and we sometimes encounter incomplete closure when the defect is located at the flexure. As, theoretically, underwater clip closure (UCC) could achieve complete closure despite these difficult cases, we investigated its feasibility. METHODS: We retrospectively analyzed 21 patients who underwent UCC after C-ESD. The main outcome was the UCC success rate, defined as complete closure of the defect. Other outcomes were procedure time, number of clips, and the delayed adverse event rate. RESULTS: The median resected specimen size was 31 mm (range 18-47 mm). The UCC success rate was 100%. The median procedure time was only 11 min (range 6-21 min). The median number of clips was 9 (range 5-16). No delayed adverse event occurred. CONCLUSION: It is feasible to use UCC to close large mucosal defects, although further studies are warranted to assess its efficacy.

    DOI: 10.1159/000492815

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  • 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. Reviewed

    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   2018.9

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    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

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  • Fecal immunochemical test and fecal calprotectin results show different profiles in disease monitoring for ulcerative colitis Reviewed

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

    Gut and Liver   12 ( 2 )   142 - 148   2018.3

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    Background/Aims: Both fecal immunochemical test (FIT) and fecal calprotectin (Fcal) results are useful biomarkers for ulcerative colitis (UC). However, the situations in which each marker should be used are largely unknown. Methods: A total of 110 colonoscopy intervals of UC patients were assessed, and correlations between changes in colonoscopic findings and changes in the two aforementioned fecal markers were examined. Results: Among patients with mucosal healing (MH) and negative FIT or Fcal results at the initial colonoscopy, FIT and Fcal findings exhibited accuracies of 93% (38/41) and 79% (26/33), respectively, for predicting the results of the subsequent examination. Among the 24 patients who showed endoscopic activity at the precedent colonoscopy and MH at the subsequent examination, positive-to-negative conversion of FIT and Fcal findings at the subsequent examination was observed in 92% (12/13) and 62% (8/13) of patients, respectively. Among the 43 patients who showed endoscopic activity at both the precedent and subsequent examinations, Fcal findings reflected the change in endoscopic activity better than FIT results (r=0.59, p&lt
    0.0001 vs r=0.30, p=0.054). Conclusions: The FIT is useful for confirming MH and the occurrence of relapse. In contrast, Fcal is useful for monitoring the mucosal status of patients with active inflammation. (Gut Liver 2018
    12:142-148).

    DOI: 10.5009/gnl17013

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  • Simultaneous measurements of faecal calprotectin and the faecal immunochemical test in quiescent ulcerative colitis patients can stratify risk of relapse Reviewed

    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   2018.1

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher: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

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  • Efficacy of restarting anti-tumor necrosis factor α agents after surgery in patients with Crohn's disease Reviewed

    Sakiko Hiraoka, Shiho Takashima, Yoshitaka Kondo, Toshihiro Inokuchi, Yuusaku Sugihara, Masahiro Takahara, Seiji Kawano, Keita Harada, Jun Kato, Hiroyuki Okada

    Intestinal Research   16 ( 1 )   75 - 82   2018

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    Background/Aims: The efficacy of anti-tumor necrosis factor a (anti-TNFα) antibodies for postoperative Crohn's disease (CD) in patients who were treated with these agents prior to surgery is largely unknown. Methods: CD patients who underwent intestinal resection and received anti-TNFα agents after surgery were divided into 2 groups according to the presence or absence of preoperative anti-TNFα treatment: anti-TNFα restart group or anti-TNFα naïve group. Endoscopic recurrence after surgery was examined according to the preoperative conditions, including administration of anti-TNFα agents before surgery. Results: Thirty-six patients received anti-TNFα antibody after surgery: 22 in the anti-TNFα restart group and 14 in the anti- TNFα naïve group. Endoscopic recurrence after surgery was more frequently observed in the anti-TNFα restart group than in the anti-TNFα naïve group (68% vs. 14%, P &lt
    0.001). Multivariate analysis revealed the following significant risk factors of endoscopic recurrence after surgery: anti-TNF restart group (odds ratio [OR], 28.10
    95% CI, 3.08-722.00), age at diagnosis &lt
    23 years (OR, 24.30
    95% CI, 1.67-1,312.00), serum albumin concentration at surgery &lt
    3.3 g/dL (OR, 34.10
    95% CI, 1.72-2,804.00), and presence of inflammation outside of the surgical site (OR, 21.40
    95% CI, 1.02-2,150.00). Treatment intensification for patients with endoscopic recurrence in the anti-TNFα restart group showed limited responses, with only 1 of 12 patients achieving endoscopic remission. Conclusions: The efficacy of restarting anti-TNFα antibody treatment after surgery was limited, and treatment intensification or a change to different classes of biologics should be considered for those patients.

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  • 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 Reviewed

    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   2017.12

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    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 &gt;= 20 mm and the ratio of the maximum diameter of prestenotic dilations to the diameter of the normal small intestine &gt;= 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 &lt; 0.001).
    Conclusions: Findings of retrograde contrast through DBE are helpful to predict risk of surgery in patients with CD with small intestinal strictures.

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  • Consecutive Measurements by Faecal Immunochemical Test in Quiescent Ulcerative Colitis Patients Can Detect Clinical Relapse Reviewed

    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   2016.6

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    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.

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  • Fecal Immunochemical Test Versus Fecal Calprotectin for Prediction of Mucosal Healing in Crohn's Disease Reviewed

    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   2016.5

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    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.

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  • Evaluation of Mucosal Healing in Ulcerative Colitis by Fecal Calprotectin Vs. Fecal Immunochemical Test Reviewed

    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   2015.6

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    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 (&lt;100 ng/ml) for predicting MH (MES 0 alone) were 0.95 and 0.62, respectively, whereas those of Fcal (&lt;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.

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  • The earliest trough concentration predicts the dose of tacrolimus required for remission induction therapy in ulcerative colitis patients Reviewed

    Sakiko Hiraoka, Jun Kato, Yuki Moritou, Daisuke Takei, Toshihiro Inokuchi, Asuka Nakarai, Sakuma Takahashi, Keita Harada, Hiroyuki Okada, Kazuhide Yamamoto

    BMC GASTROENTEROLOGY   15   53   2015.4

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    Background: Oral tacrolimus therapy is effective for refractory ulcerative colitis (UC), but dose adjustment according to the trough concentrations which varies largely among individuals, is required. This study aimed to identify factors to predict the tacrolimus dose required for achieving the target trough level for remission induction of UC.
    Methods: Forty-seven consecutive UC patients who were treated with tacrolimus were retrospectively analyzed. Tacrolimus doses were adjusted every 2 or 3 days to achieve trough concentrations of 10-15 ng/mL. The dose required for reaching the target trough level was analyzed based on disease characteristics, course of trough concentrations, and gene polymorphism related to tacrolimus metabolism.
    Results: Median daily dose of tacrolimus required for achieving the target trough level was 0.19 (0.07-0.42) mg/kg, and patients were divided into high or low dose group (&lt; 0.2 mg/kg or &gt; 0.2 mg/kg). The value of initial trough concentration/starting dose was higher in the low dose group than in the high dose group (1.35 ng/mL/mg vs. 0.78 ng/mL/mg, p &lt; 0.0001). Although presence of CYP3A5 *1 was more frequently observed in the high dose group, initial trough concentration was the only significant factor for determining requirement of high dose of tacrolimus (OR = 28.0, 95% confidence interval 3.20 - 631).
    Conclusions: The most practical predictor of the dose required for achieving the target trough concentration was the trough concentration measured 2 or 3 days after starting tacrolimus therapy. Our findings would make tarcolimus administration for UC safer, easier and more effective.

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  • Evaluation of Mucosal Healing of Ulcerative Colitis by a Quantitative Fecal Immunochemical Test Reviewed

    Asuka Nakarai, Jun Kato, Sakiko Hiraoka, Motoaki Kuriyama, Mitsuhiro Akita, Tomoko Hirakawa, Hiroyuki Okada, Kazuhide Yamamoto

    AMERICAN JOURNAL OF GASTROENTEROLOGY   108 ( 1 )   83 - 89   2013.1

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    OBJECTIVES: Accumulating evidence has underlined the importance of mucosal healing as a treatment goal for ulcerative colitis (UC). Quantitative fecal immunochemical tests (FITs), which can rapidly quantify fecal blood with automated equipment, have been used recently to screen for colorectal neoplasia. The aim of this study is to determine whether an FIT can evaluate mucosal healing in UC.
    METHODS: Feces collected from UC patients who underwent colonoscopy were examined by FITs, and results were compared with colonoscopic findings. Mucosal status was assessed using the Mayo endoscopic subscore classification. Maximum score for the colorectum in each patient was recorded.
    RESULTS: Evaluated were FIT results in conjunction with 310 colonoscopies that were performed in 152 UC patients. A large majority of patients with a Mayo 0 endoscopic score had negative FIT (&lt;100 ng/ml) results (92 %), and the proportion of negative FIT results decreased with increases in the Mayo score (Mayo 1: 47 %, Mayo 2: 13 %, Mayo 3: 12 %, P &lt; 0.0001, Cochran-Armitage trend test). When the negative FIT was defined as &lt; 100 ng/ml, the sensitivity and specificity of a negative FIT for mucosal healing (Mayo 0) were 0.92 and 0.71, respectively. When mucosal healing was defined as Mayo 0 or 1, those were 0.60 and 0.87, respectively. In addition, a positive FIT (&gt;= 100 ng/ml) predicted mucosal inflammation (Mayo 2 or 3) with sensitivity 0.87 and specificity 0.60, respectively.
    CONCLUSIONS: The FIT can effectively and noninvasively evaluate mucosal healing in UC. This easy, rapid method can help evaluate and control disease activity of UC.

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  • Readministration of Calcineurin Inhibitors for Ulcerative Colitis Reviewed

    Sakiko Hiraoka, Jun Kato, Hideyuki Suzuki, Kazuhide Yamamoto

    ANNALS OF PHARMACOTHERAPY   46 ( 10 )   1315 - 1321   2012.10

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    BACKGROUND: Calcineurin inhibitors (CNIs) such as cyclosporine and tacrolimus have been shown to be effective for treatment of patients with steroid-dependent or steroid-refractory ulcerative colitis (UC) with moderate to severe activity. However, it has not been determined whether readministration of CNIs is effective in patients who experience relapse after remission induced by CNIs.
    OBJECTIVE: To determine the effect of readministration of CNIs in patients who had initially responded to CNIs.
    METHODS: A review of the medical records of 46 patients with moderate to severe UC who were treated with a CNI at a single tertiary teaching hospital with 840 beds was conducted. Remission was defined as a clinical activity index (CAI) score of 3 or less within 2 months of starting CNI therapy. Response was defined as a CAI score of 4 or higher but had decreased by half from the start of CNI therapy. Relapse was defined as flare-up of symptoms that required an additional treatment or colectomy.
    RESULTS: Of the 46 patients, 37 (80%) achieved clinical remission or response with the initial CNI treatment. Among those 37 patients, 19 experienced relapse (median duration to relapse, 6.4 months), 12 of whom were readministered a CNI. Of the 12 patients, 2 achieved clinical remission, 2 had a response, and the remaining 8 had no response to the CNI. In addition, all patients who responded to CNI readministration experienced relapse within 6 months. CNI readministration was significantly less effective than the initial administration for treatment of UC (80% vs 33%; p = 0.0014).
    CONCLUSIONS: Readministration of CNIs for relapse after remission with CNI treatment does not seem to be successful. Alternative therapies such as anti-tumor necrosis factor antibody should be used or colectomy should be considered.

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  • The Presence of Large Serrated Polyps Increases Risk for Colorectal Cancer Reviewed

    Sakiko Hiraoka, Jun Kato, Shigeatsu Fujiki, Eisuke Kaji, Tamiya Morikawa, Takatoshi Murakami, Toru Nawa, Motoaki Kuriyama, Toshio Uraoka, Nobuya Ohara, Kazuhide Yamamoto

    GASTROENTEROLOGY   139 ( 5 )   1503 - +   2010.11

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    BACKGROUND & AIMS: There is evidence that serrated polyps (serrated adenomas and hyperplastic polyps) have different malignant potential than traditional adenomas. We used a colonoscopy database to determine the association between the presence of serrated colorectal polyps and colorectal neoplasia. METHODS: We performed a multicenter observational study of 10,199 subjects who underwent first-time colonoscopies. Data collected on study subjects included age and sex and the location, size, and histology of polyps or tumors found at colonoscopy. Serrated polyps were defined as those diagnosed by the pathologists in the participating hospitals as a serrated lesion (a lesion given the term of "classical hyperplastic polyp," "traditional serrated adenoma," " sessile serrated adenoma," or "mixed serrated polyp"). Large serrated polyps (LSPs) were defined as those &gt;= 10 mm. RESULTS: There were 1573 patients (15.4%) with advanced neoplasia, 708 patients (6.9%) with colorectal cancer (CRC), and 140 patients (1.4%) with LSPs in our cohort. Multivariate analysis associated the presence of LSPs with advanced neoplasia (odds ratio [OR], 4.01; 95% confidence interval [CI], 2.83-5.69) and CRC (OR, 3.34; 95% CI, 2.16-5.03). The presence of LSPs was the greatest risk factor for CRC, particularly for proximal CRC (OR, 4.79; 95% CI, 2.54-8.42). Proximal and protruded LSPs were the highest risk factors for proximal CRC (OR, 5.36; 95% CI, 2.40-10.8 and OR, 9.00; 95% CI, 2.75-19.2, respectively). CONCLUSIONS: The presence of LSPs is a risk factor for CRC, particularly CRC of the proximal colon.

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  • Laterally spreading type of colorectal adenoma exhibits a unique methylation phenotype and K-ras mutations Reviewed

    Sakiko Hiraoka, Jun Kato, Masashi Tatsukawa, Keita Harada, Hideyuki Fujita, Tamiya Morikawa, Hidenori Shiraha, Yasushi Shiratori

    GASTROENTEROLOGY   131 ( 2 )   379 - 389   2006.8

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    Background & Aims: Laterally spreading tumors (LST), characterized by superficial extension along the colonic lumen, have recently been detected by colonoscopy. However, genetic and epigenetic characteristics of these tumors were scarcely reported. Methods: A total of 205 sporadic colorectal adenoma tissues (157 protruded-type, 23 granular-type LST (G-LST), 12 flat-type LST (FLST), and 13 flat-type smaller than 1 cm) were collected. CpG island methylator phenotype (CIMP) was determined by examination of methylation status at p16, methylated in tumor (MINT) 1, 2, 12, and 31 loci. K-ras codon 12 and 13 point mutations were also examined. The relationship between macroscopic appearance and CIMP status or K-ras mutations was analyzed. Results: Among adenomas larger than 1 cm, CpG island methylation involving 2 or more loci (CIMP-high) was more likely to be observed in G-LST (14/23, 61%) than in protruded-type adenomas (18/73, 25%) (P=.002). The prevalence of K-ras mutations in G-LST (18/23, 78%) was significantly higher than that in protruded-type adenomas (18/73, 25%) (P &lt;.0001). Moreover, the prevalence of CIMP-high and K-ras mutations in G-LST located in the proximal colon was much higher (11/13, 85%; and 12/13, 92%, respectively). In contrast, F-LST exhibited low prevalence of CIMP-high (1/12, 8%) and K-ras mutations (2/12, 16%). Conclusions: High prevalence of CIMP-high and K-ras mutations in G-LST, especially in the proximal colon, could strongly suggest that G-LST appearance is associated with a unique carcinogenic pathway.

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  • Enhanced expression of decay-accelerating factor, a complement-regulatory protein, in the specialized intestinal metaplasia of Barrett's esophagus Reviewed

    S Hiraoka, M Mizuno, J Nasu, H Okazaki, C Makidono, H Okada, R Terada, K Yamamoto, T Fujita, Y Shiratori

    JOURNAL OF LABORATORY AND CLINICAL MEDICINE   143 ( 4 )   201 - 206   2004.4

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    Intestinal-type epithelium in Barrett's esophagus, so-called specialized intestinal metaplasia (SIM), is a risk factor for the development of esophageal adenocarcinoma. Surface expression of decay-accelerating factor (DAF), a complement-regulatory protein, is markedly enhanced in intestinal metaplasia of the gastric mucosa. We therefore examined DAF expression in areas of SIM in Barrett's esophagus in an attempt to determine whether DAF is a biomarker of SIM. We obtained 53 endoscopic biopsy specimens from the esophageal columnar mucosae of 45 patients. We immunohistochemically examined the distribution of DAF and 2 other complement-regulatory proteins: homologous restriction factor-20 and membrane cofactor protein. We also examined the expression of DAF messenger RNA in SIM with the use of laser-capture microdissection and reverse transcription-polymerase chain reaction. Of the 53 specimens, 10 were found histologically to involve areas of SIM, 41 were SIM-negative epithelium, and 2 comprised areas of SIM and SIM-negative epithelium. DAF staining was negligible in 35 of 43 specimens of the SIM-negative columnar epithelium, but DAF was strongly stained on the apical surface in all 12 SIM-positive specimens (P &lt;.0001). In the 2 biopsy specimens in which both SIM and SIM-negative columnar epithelium were present, DAF staining was confined to the area of SIM. The expression of DAF messenger RNA was detected significantly more often in SIM than in SIM-negative columnar epithelium (P =.022). We conclude that DAF may be a surface marker for SIM and therefore useful in the identification of areas of the mucosa at risk for the development of adenocarcinoma in Barrett's esophagus.

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

    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   2024.2

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    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.

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  • Coffee and caffeine intake reduces risk of ulcerative colitis: a case-control study in Japan. International journal

    Keiko Tanaka, Hitomi Okubo, Yoshihiro Miyake, Chisato Nagata, Shinya Furukawa, Akira Andoh, Tetsuji Yokoyama, Naoki Yoshimura, Kenichiro Mori, Tomoyuki Ninomiya, Yasunori Yamamoto, Eiji Takeshita, Yoshio Ikeda, Mitsuru Saito, Katsuhisa Ohashi, Hirotsugu Imaeda, Kazuki Kakimoto, Kazuhide Higuchi, Hiroaki Nunoi, Yuji Mizukami, Seiyuu Suzuki, Sakiko Hiraoka, Hiroyuki Okada, Keitarou Kawasaki, Masaaki Higashiyama, Ryota Hokari, Hiromasa Miura, Teruki Miyake, Teru Kumagi, Hiromasa Kato, Naohito Hato, Koji Sayama, Yoichi Hiasa

    Journal of gastroenterology and hepatology   2023.12

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    BACKGROUND AND AIM: Although diet is one of the potential environmental factors affecting ulcerative colitis (UC), evidence is not sufficient to draw definitive conclusions. This Japanese case-control study examined the association between the consumption of coffee, other caffeine-containing beverages and food, and total caffeine and the risk of UC. METHODS: The study involved 384 UC cases and 665 control subjects. Intake of coffee, decaffeinated coffee, black tea, green tea, oolong tea, carbonated soft drinks, and chocolate snacks was measured with a semiquantitative food-frequency questionnaire. Adjustments were made for sex, age, pack-years of smoking, alcohol consumption, history of appendicitis, family history of UC, education level, body mass index, and intake of vitamin C, retinol, and total energy. RESULTS: Higher consumption of coffee and carbonated soft drinks was associated with a reduced risk of UC with a significant dose-response relationship (P for trend for coffee and carbonated soft drinks were <0.0001 and 0.01, respectively), whereas higher consumption of chocolate snacks was significantly associated with an increased risk of UC. No association was observed between consumption of decaffeinated coffee, black tea, green tea, or oolong tea and the risk of UC. Total caffeine intake was inversely associated with the risk of UC; the adjusted odds ratio between extreme quartiles was 0.44 (95% confidence interval: 0.29-0.67; P for trend <0.0001). CONCLUSIONS: We confirmed that intake of coffee and caffeine is also associated with a reduced risk of UC in Japan where people consume relatively low quantities of coffee compared with Western countries.

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

    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   2023.10

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    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.

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  • Trajectory analyses to identify persistently low responders to COVID-19 vaccination in patients with inflammatory bowel disease: a prospective multicentre controlled study, J-COMBAT.

    Kenji Watanabe, Masanori Nojima, Hiroshi Nakase, Toshiyuki Sato, Minoru Matsuura, Nobuo Aoyama, Taku Kobayashi, Hirotake Sakuraba, Masakazu Nishishita, Kaoru Yokoyama, Motohiro Esaki, Fumihito Hirai, Masakazu Nagahori, Sohachi Nanjo, Teppei Omori, Satoshi Tanida, Yoshihiro Yokoyama, Kei Moriya, Atsuo Maemoto, Osamu Handa, Naoki Ohmiya, Kiichiro Tsuchiya, Shinichiro Shinzaki, Shingo Kato, Toshio Uraoka, Hiroki Tanaka, Noritaka Takatsu, Atsushi Nishida, Junji Umeno, Masanao Nakamura, Yoshiyuki Mishima, Mikihiro Fujiya, Kenji Tsuchida, Sakiko Hiraoka, Makoto Okabe, Takahiko Toyonaga, Katsuyoshi Matsuoka, Akira Andoh, Yoshio Hirota, Tadakazu Hisamatsu

    Journal of gastroenterology   58 ( 10 )   1015 - 1029   2023.10

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    BACKGROUND: The degree of immune response to COVID-19 vaccination in inflammatory bowel disease (IBD) patients based on actual changes in anti-SARS-CoV-2 antibody titres over time is unknown. METHODS: Data were prospectively acquired at four predetermined time points before and after two vaccine doses in a multicentre observational controlled study. The primary outcome was humoral immune response and vaccination safety in IBD patients. We performed trajectory analysis to identify the degree of immune response and associated factors in IBD patients compared with controls. RESULTS: Overall, 645 IBD patients and 199 control participants were analysed. At 3 months after the second vaccination, the seronegative proportions were 20.3% (combination of anti-tumour necrosis factor [TNF]α and thiopurine) and 70.0% (triple combination including steroids), despite that 80.0% receiving the triple combination therapy were seropositive at 4 weeks after the second vaccination. Trajectory analyses indicated three degrees of change in immune response over time in IBD patients: high (57.7%), medium (35.6%), and persistently low (6.7%). In the control group, there was only one degree, which corresponded with IBD high responders. Older age, combined anti-TNFα and thiopurine (odds ratio [OR], 37.68; 95% confidence interval [CI], 5.64-251.54), steroids (OR, 21.47; 95%CI, 5.47-84.26), and tofacitinib (OR, 10.66; 95%CI, 1.49-76.31) were factors associated with persistently low response. Allergy history (OR, 0.17; 95%CI, 0.04-0.68) was a negatively associated factor. Adverse reactions after the second vaccination were significantly fewer in IBD than controls (31.0% vs 59.8%; p < 0.001). CONCLUSIONS: Most IBD patients showed a sufficient immune response to COVID-19 vaccination regardless of clinical factors. Assessment of changes over time is essential to optimize COVID-19 vaccination, especially in persistently low responders.

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  • Vulvar Crohn's disease presenting with multiple exophytic nodules and labial swelling: A case report. International journal

    Ai Kajita, Yoshio Kawakami, Sakiko Hiraoka, Junko Haraga, Shin Morizane

    The Journal of dermatology   50 ( 12 )   e411-e412   2023.8

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  • Predictive Factors for Efficacy of Oral Tacrolimus Induction Therapy in Moderate to Severe Ulcerative Colitis Patients: Large Multicenter Retrospective Cohort Study. International journal

    Naoki Oshima, Sakiko Hiraoka, Ryohei Hayashi, Sakuma Takahashi, Manabu Ishii, Shinichi Hashimoto, Kazuo Yashima, Shoko Igawa, Toshihiro Inokuchi, Yoshitaka Ueno, Tomoki Inaba, Hiroshi Matsumoto, Kousaku Kawashima, Taro Takami, Hajime Isomoto, Akiko Shiotani, Shinji Tanaka, Shunji Ishihara

    Inflammatory bowel diseases   2023.8

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    BACKGROUND: Tacrolimus (TAC), a calcineurin inhibitor, is used for remission induction therapy in patients with moderate to severe ulcerative colitis (UC), with short-term efficacy and related predictive factors shown in previous cohort studies. However, most studies reported data for only a limited number of patients enrolled from a single center. We performed a large multicenter retrospective cohort study to identify factors related to prediction of clinical remission in UC patients treated with oral TAC. METHODS: The medical records of patients with moderate to severe UC treated with oral TAC as induction therapy at 7 institutions between April 2009 and March 2017 were retrospectively reviewed. RESULTS: A total of 216 patients who received TAC for induction were analyzed, of whom 123 (56.9%) showed clinical remission at week 12. Logistic regression analysis indicated that previous or current use of antitumor necrosis factor (TNF)-α antibodies (odds ratio [OR], 0.259; P = .006), and concomitant treatment with 5-aminosalicylate (5-ASA) at the baseline (OR, 0.268; P = .005) were independent predictive factors correlated with failure of clinical remission, whereas higher levels of C-reactive protein (OR, 1.124; P = .014) predicted achievement of clinical remission. CONCLUSIONS: Results of this multicenter study clearly indicate the efficacy of TAC induction therapy for patients with moderate to severe UC. Notably, previous or current use of anti-TNF-α antibodies was associated with poor achievement of clinical remission by week 12.

    DOI: 10.1093/ibd/izad150

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  • 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   2023.6

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  • Anxiety and behavioral changes in Japanese patients with inflammatory bowel disease due to COVID-19 pandemic: a national survey.

    Hiroshi Nakase, Kohei Wagatsuma, Masanori Nojima, Takayuki Matsumoto, Minoru Matsuura, Hideki Iijima, Katsuyoshi Matsuoka, Naoki Ohmiya, Shunji Ishihara, Fumihito Hirai, Ken Takeuchi, Satoshi Tamura, Fukunori Kinjo, Nobuhiro Ueno, Makoto Naganuma, Kenji Watanabe, Rintaro Moroi, Nobuaki Nishimata, Satoshi Motoya, Koichi Kurahara, Sakuma Takahashi, Atsuo Maemoto, Hirotake Sakuraba, Masayuki Saruta, Keiichi Tominaga, Takashi Hisabe, Hiroki Tanaka, Shuji Terai, Sakiko Hiraoka, Hironobu Takedomi, Kazuyuki Narimatsu, Katsuya Endo, Masanao Nakamura, Tadakazu Hisamatsu

    Journal of gastroenterology   58 ( 3 )   205 - 216   2023.3

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    BACKGROUND: Given the increasing health concerns for patients with inflammatory bowel disease (IBD), amidst the COVID-19 pandemic, we investigated the impact of the pandemic on the anxiety and behavioral changes in Japanese patients with IBD. METHODS: We analyzed 3032 questionnaires from patients with IBD, aged 16 years or older visiting 30 hospitals and 1 clinic between March 2020 and June 2021. The primary outcome was the score of the anxiety experienced by patients with IBD during the pandemic. RESULTS: Participants reported a median age of 44 years; 43.3% of the patients were women. Moreover, 60.6% and 39.4% were diagnosed with ulcerative colitis and Crohn's disease, respectively, with a median disease duration of 10 years. Participants indicated an average of disease-related anxiety score of 5.1 ± 2.5 on a ten-point scale, with a tendency to increase, 1 month after the number of infected persons per population increased. The top three causes for anxiety were the risk of contracting COVID-19 during hospital visits, SARS-CoV-2 infection due to IBD, and infection by IBD medication. Factors associated with anxiety were gender (women), being a homemaker, hospital visit timings, mode of transportation (train), use of immunosuppressive drugs, and nutritional therapy. Most patients continued attending their scheduled hospital visits, taking their medications, experienced the need for a family doctor, and sought guidance and information regarding COVID-19 from primary doctors, television, and Internet news. CONCLUSIONS: Patients with IBD experienced moderate disease-related anxiety due to the pandemic and should be proactively informed about infectious diseases to relieve their anxiety.

    DOI: 10.1007/s00535-022-01949-6

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  • RNA editing is a valuable biomarker for predicting carcinogenesis in ulcerative colitis. International journal

    Kazutaka Takahashi, Kunitoshi Shigeyasu, Yoshitaka Kondo, Kazuyoshi Gotoh, Shuya Yano, Yuzo Umeda, Toshihiro Inokuchi, Caiming Xu, Kazuhiro Yoshida, Hibiki Umeda, Toshiaki Takahashi, Sho Takeda, Ryuichi Yoshida, Fuminori Teraishi, Hiroyuki Kishimoto, Yoshiko Mori, Kazuhiro Noma, Yoshinaga Okugawa, Sakiko Hiraoka, Hiroyuki Michiue, Hiroshi Tazawa, Osamu Matsushita, Ajay Goel, Toshiyoshi Fujiwara

    Journal of Crohn's & colitis   17 ( 5 )   754 - 766   2022.12

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    BACKGROUND AND AIMS: Ulcerative colitis (UC) can develop colitis-associated colorectal neoplasm (CAN). Adenine-to-inosine RNA editing, which is regulated by adenosine deaminase acting on RNA (ADAR), induces the posttranscriptional modification of critical oncogenes, including antizyme inhibitor 1 (AZIN1), leading to colorectal carcinogenesis. Therefore, we hypothesized that ADAR1 might be involved in the development of CAN in UC. METHODS: We systematically analyzed a cohort of 139 UC cases (40 acute phase, 73 remission phase, 26 CAN). The degree of inflammation was evaluated using the Mayo endoscopic score (MES). RESULTS: The type 1 IFN-related inflammation pathway was upregulated in the rectum of active UC, rectum of UC-CAN, and tumor site of UC-CAN patients. ADAR1 expression was upregulated in the entire colon of CAN cases, while it was down-regulated in non-CAN MES0 cases. ADAR1 expression in the rectum predicted the development of CAN better than p53 or β-catenin, with an area under the curve of 0.93. The high expression of ADAR1 and high AZIN1 RNA editing in UC was triggered by type 1 IFN stimulation from UC-specific microbiomes, such as Fusobacterium in vitro analyses. The induction of AZIN1 RNA editing by ADAR1, whose expression is promoted by Fusobacterium, may induce carcinogenesis in UC. CONCLUSIONS: The risk of CAN can be evaluated by assessing ADAR1 expression in the rectum of MES0 UC patients, freeing UC patients from unnecessary colonoscopy and reducing their physical burden. RNA editing may be involved in UC carcinogenesis, and may be used to facilitate the prevention and treatment of CAN in UC.

    DOI: 10.1093/ecco-jcc/jjac186

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  • 【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   2022.11

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    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)

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    Other Link: 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

  • 手技の解説 クローン病におけるダブルバルーン内視鏡下逆行性造影の実際

    井口 俊博, 川野 誠司, 平岡 佐規子

    Gastroenterological Endoscopy   64 ( 10 )   2308 - 2316   2022.10

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    クローン病患者の7割以上が小腸病変を有するとされ,小腸病変のモニタリングとその制御は患者のQOLに直結する.従ってクローン病診療では,全小腸を高精度でかつ手軽に,そして低侵襲にモニタリングすることが求められるが,残念ながらすべてを兼ね備えた検査やマーカーは未だ存在しない.ダブルバルーン内視鏡検査は,クローン病小腸病変に対するモニタリング検査の1つとして,また時に内視鏡的拡張術目的に広く使用されている.当科ではダブルバルーン内視鏡検査の際に通常の観察に加えて先端バルーンを拡張させて逆行性造影を行い,それまでは難しかった深部小腸の評価をルーチンで行っている.本稿では,クローン病小腸病変に対するダブルバルーン内視鏡下逆行性造影の手順やコツを解説する.(著者抄録)

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  • 【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   2022.10

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  • 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   2022.10

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

    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   2022.9

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    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

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  • IL12B rs6887695 polymorphism and interaction with alcohol intake in the risk of ulcerative colitis in Japan. International journal

    Yoshihiro Miyake, Keiko Tanaka, Chisato Nagata, Shinya Furukawa, Akira Andoh, Tetsuji Yokoyama, Naoki Yoshimura, Kenichiro Mori, Tomoyuki Ninomiya, Yasunori Yamamoto, Eiji Takeshita, Yoshio Ikeda, Mitsuru Saito, Katsuhisa Ohashi, Hirotsugu Imaeda, Kazuki Kakimoto, Kazuhide Higuchi, Hiroaki Nunoi, Yuji Mizukami, Seiyuu Suzuki, Sakiko Hiraoka, Hiroyuki Okada, Keitarou Kawasaki, Masaaki Higashiyama, Ryota Hokari, Hiromasa Miura, Teruki Miyake, Teru Kumagi, Hiromasa Kato, Naohito Hato, Koji Sayama, Yoichi Hiasa

    Cytokine   155   155901 - 155901   2022.7

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    BACKGROUND: The interleukin (IL)-23/Th17 pathway plays a critical role in ulcerative colitis (UC). The IL-12p40 subunit, which is shared by IL-23 and IL-12, is encoded by the IL12B gene. The current case-control study investigated the association between IL12B SNP rs6887695 and the UC risk. METHODS: There were 384 cases within 4 years of UC diagnosis and 661 controls who were enrolled. Adjustments were made for sex, age, pack-years of smoking, alcohol consumption, history of appendicitis, family history of UC, education level, and body mass index. RESULTS: Subjects with the GG IL12B SNP rs6887695 genotype had a significantly increased risk of UC compared with those with the CC genotype (adjusted odds ratio [AOR], 1.60; 95% confidence interval [CI], 1.08-2.36). This positive association was also significant using the additive and recessive models (AOR, 1.25; 95% CI, 1.03-1.52; AOR, 1.50; 95% CI, 1.08-2.09, respectively). An independent inverse relationship was observed between ever alcohol consumption and the UC risk in those with the CC genotype while no significant association was found in those with at least one G allele (P for interaction = 0.0008). CONCLUSIONS: IL12B SNP rs6887695 was significantly associated with UC. The influence of alcohol consumption might rely on rs6887695.

    DOI: 10.1016/j.cyto.2022.155901

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  • 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   2022.7

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  • Usefulness of Intestinal Ultrasound to Detect Small Intestinal Stenosis in Patients with Crohn's Disease. International journal

    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   2022.6

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    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

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  • 【潰瘍性大腸炎 内科診療の即戦力を身につける!-急増する患者の日常診療に求められる必須アップデート-】基準治療 5-ASA製剤と局所製剤の最適化 熟知し使いこなす!

    安富 絵里子, 井口 俊博, 平岡 佐規子

    消化器内科   4 ( 6 )   40 - 47   2022.6

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    5-aminosalicylic acid(5-ASA)製剤は軽症から中等症までの潰瘍性大腸炎(UC)の寛解導入・寛解維持の両方に用いることのできる基本薬である。日本ではサラゾスルファピリジンと3種類のメサラジン製剤およびそれらのジェネリック製剤、局所製剤(坐剤・注腸製剤)を使用することができる。5-ASA製剤の最大用量の投与により7割前後の症例で有効性が見込まれる。5-ASA製剤による治療中に再燃をきたした場合はアドヒアランスや用量の確認、局所製剤の追加や5-ASA製剤のローテーションも考慮される。また、5-ASA製剤は安全性の高い薬であるが、気を付けるべき副作用もある。特に、治療開始1〜2週間後に発熱、下痢、腹痛の悪化を呈した場合は5-ASA製剤によるアレルギーを疑う。UCの増悪と鑑別が難しい場合もあるが、疑わしい症例に遭遇した場合は5-ASAアレルギーの可能性を念頭におき、製剤を中止することが必要である。(著者抄録)

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  • 【Common diseaseとなった潰瘍性大腸炎の現状と診療のコツ】5-ASA製剤の種類,適応症例と使い方および副作用 不耐も含めて

    安富 絵里子, 井口 俊博, 平岡 佐規子

    臨床消化器内科   37 ( 7 )   759 - 764   2022.6

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    <文献概要>5-アミノサリチル酸(5-ASA)製剤は潰瘍性大腸炎(UC)の寛解導入と寛解維持に有効であり,軽症〜中等症のUCに用いる基本薬である.本邦ではサラゾスルファピリジンと3種類のメサラジン製剤を用いることが可能で,それぞれ5-ASAの放出機構,薬物動態に特徴がある.寛解導入効果は標準用量から高用量の5-ASAで有効性が認められており,十分量の投与が必要である.また,寛解維持にはアドヒアランスの遵守が重要である.5-ASAは全身の免疫抑制作用はなく安全性は高いとされるが,副作用もある.とくに,腹部症状の悪化をきたす「5-ASAアレルギー」と呼ばれるものがあり,5-ASA製剤内服開始1〜2週間程度で出現することが多い.近年その増加も指摘されており,注意を要する.

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  • The diagnostic ability to classify neoplasias occurring in inflammatory bowel disease by artificial intelligence and endoscopists: A pilot study. International journal

    Shumpei Yamamoto, Hideaki Kinugasa, Kenta Hamada, Masahiro Tomiya, Takayoshi Tanimoto, Akimitsu Ohto, Akira Toda, Daisuke Takei, Minoru Matsubara, Seiyu Suzuki, Kosuke Inoue, Takehiro Tanaka, Sakiko Hiraoka, Hiroyuki Okada, Yoshiro Kawahara

    Journal of gastroenterology and hepatology   37 ( 8 )   1610 - 1616   2022.5

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    BACKGROUND AND AIM: Although endoscopic resection with careful surveillance instead of total proctocolectomy become to be permitted for visible low-grade dysplasia, it is unclear how accurately endoscopists can differentiate these lesions, as classifying neoplasias occurring in inflammatory bowel disease (IBDN) is exceedingly challenging due to background chronic inflammation. We evaluated a pilot model of an artificial intelligence (AI) system for classifying IBDN and compared it with the endoscopist's ability. METHODS: This study used a deep convolutional neural network, the EfficientNet-B3. Among patients who underwent treatment for IBDN at two hospitals between 2003 and 2021, we selected 862 non-magnified endoscopic images from 99 IBDN lesions and utilized 6 375 352 images that were increased by data augmentation for the development of AI. We evaluated the diagnostic ability of AI using two classifications: the "adenocarcinoma/high-grade dysplasia" and "low-grade dysplasia/sporadic adenoma/normal mucosa" groups. We compared the diagnostic accuracy between AI and endoscopists (three non-experts and four experts) using 186 test set images. RESULTS: The diagnostic ability of the experts/non-experts/AI for the two classifications in the test set images had a sensitivity of 60.5% (95% confidence interval [CI]: 54.5-66.3)/70.5% (95% CI: 63.8-76.6)/72.5% (95% CI: 60.4-82.5), specificity of 88.0% (95% CI: 84.7-90.8)/78.8% (95% CI: 74.3-83.1)/82.9% (95% CI: 74.8-89.2), and accuracy of 77.8% (95% CI: 74.7-80.8)/75.8% (95% CI: 72-79.3)/79.0% (95% CI: 72.5-84.6), respectively. CONCLUSIONS: The diagnostic accuracy of the two classifications of IBDN was higher than that of the experts. Our AI system is valuable enough to contribute to the next generation of clinical practice.

    DOI: 10.1111/jgh.15904

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  • Fever and electrocoagulation syndrome after colorectal endoscopic submucosal dissection for patients with immunosuppressants and steroids. International journal

    Shumpei Yamamoto, Hideaki Kinugasa, Yasushi Yamasaki, Mami Hirai, Soichiro Ako, Kensuke Takei, Shoko Igawa, Eriko Yasutomi, Shohei Oka, Masayasu Ohmori, Toshihiro Inokuchi, Keita Harada, Sakiko Hiraoka, Kazuhiro Nouso, Takehiro Tanaka, Hiroyuki Okada

    DEN open   2 ( 1 )   e83   2022.4

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    OBJECTIVES: Transient fever and electrocoagulation syndrome after colorectal endoscopic submucosal dissection (ESD) remain a challenge. The aim of this study was to assess the risk factors of post-ESD fever and post-ESD coagulation syndrome (PECS), focusing on the involvement of immunosuppressive drugs and steroids (IM). METHODS: This retrospective analysis included 510 patients who underwent colorectal ESD at Okayama University Hospital from 2015 to 2020. The incidence rate, clinical outcome, and factors associated with post-ESD fever and PECS were investigated. RESULTS: Post-ESD fever and PECS occurred in 63 patients (12.4%) and 43 patients (8.4%), respectively. In multivariate analysis, the American Society of Anesthesiologists Physical Status ≥3, the use of immunosuppressants or prednisolone ≥5mg (IM group), and injury to muscle layer/perforation were significantly associated with post-ESD fever. In PECS, IM group, tumors located on the right side, treatment time ≥60 min, injury to the muscle layer, and multiple lesions were independent risk factors. Both post-ESD fever and PECS improved conservatively in the IM group, and no serious complication was observed. CONCLUSIONS: The use of IM was a risk factor for both post-ESD fever and PECS. However, there were no serious complications in colorectal ESD for patients taking IM.

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  • 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   2022.4

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  • 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   2022.4

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  • Metformin ameliorates chronic colitis in a mouse model by regulating interferon-γ-producing lamina propria CD4+ T cells through AMPK activation. International journal

    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   2022.2

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    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.

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  • A consensus statement on health-care transition for childhood-onset inflammatory bowel disease patients. International journal

    Hideki Kumagai, Toshiaki Shimizu, Itaru Iwama, Shin-Ichiro Hagiwara, Takahiro Kudo, Michiko Takahashi, Takeshi Saito, Reiko Kunisaki, Motoi Uchino, Sakiko Hiraoka, Makoto Naganuma, Ken Sugimoto, Jun Miyoshi, Tomoyoshi Shibuya, Tadakazu Hisamatsu

    Pediatrics international : official journal of the Japan Pediatric Society   64 ( 1 )   e15241   2022.1

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    Inflammatory bowel disease (IBD) is a chronic relapsing inflammatory disorder of the intestine. The incidence of IBD is increasing worldwide, including Japan, and in approximately 25% of all affected patients it is diagnosed before 18 years of age. For the health maintenance of such patients, planned transition to adult care systems is essential. Previous Japanese surveys have revealed gaps between adult and pediatric gastroenterologists with regard to their knowledge and perception of health-care transition for patients with childhood-onset IBD. In 2021-2022, several Web workshops to discuss issues related to the transitional care of IBD patients were held by the Ministry of Health, Labour and Welfare of Japan as part of their program for research on intractable diseases. Clinicians experienced in IBD treatment for pediatric and adult patients participated. As a result, this panel of adult and pediatric gastroenterologists developed five consensus statements on the issue of "transfer from pediatric to adult care" and nine statements on the issue of "addressing transitional care (transition program)." To address current gaps in health-care transition for childhood-onset IBD patients, a programmed approach to transition, and better partnerships between pediatric and adult gastroenterologists are indicated. It is hoped that this consensus statement will provide a basis for the development of appropriate guidelines for clinical practice.

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  • 潰瘍性大腸炎患者における直腸粘膜内のリンパ球分画構成の検討

    岩室 雅也, 高橋 孝英, 田中 健大, 平岡 佐規子, 岡田 裕之

    日本消化管学会雑誌   6 ( Suppl. )   208 - 208   2022.1

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  • [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

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    DOI: 10.11405/nisshoshi.119.992

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  • Enriched CD45RA-CD62L+ central memory T and decreased CD3+CD56+ natural killer T lymphocyte subsets in the rectum of ulcerative colitis patients. International journal

    Masaya Iwamuro, Takahide Takahashi, Natsuki Watanabe, Takehiro Tanaka, Toshihiro Inokuchi, Sakiko Hiraoka, Fumio Otsuka, Hiroyuki Okada

    International journal of immunopathology and pharmacology   36   20587384211051982 - 20587384211051982   2022

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    OBJECTIVES: To investigate the distinctive features of lymphocytes promoting inflammation in ulcerative colitis. METHODS: We performed flow cytometric analysis of peripheral blood mononuclear cells (PBMCs) and colorectal mucosa lymphocytes in ulcerative colitis patients (n = 13) and control patients (n = 5). RESULTS: CD62L+/CD3+CD4+ (35.7 ± 14.0% vs. 19.9 ± 6.4%) and CD62L+/CD3+CD4- cells (17.1 ± 17.4% vs. 2.4 ± 3.9%) were higher in the rectum of ulcerative colitis patients than in control patients. Subpopulation analysis revealed that CD45RA-CD62L+/CD3+CD4+, that is, central memory T cell fraction in CD4+ T cells, was significantly increased in the rectum of ulcerative colitis, compared to that in control patients (23.3 ± 10.5% vs. 8.2 ± 4.0%). Comparison of rectum and colon samples in ulcerative colitis patients indicated that CD56+/CD3+ was decreased in the rectum compared to that in the colon (11.3 ± 12.5% vs. 21.3 ± 16.5%). The ratio of CD56+/CD3+ was also decreased in the rectum of active ulcerative colitis patients compared to that in ulcerative colitis patients at the endoscopic remission stages (2.8 ± 1.7% vs. 18.5 ± 13.3%). CONCLUSION: We demonstrated that CD62L+ T lymphocytes, particularly the CD45RA-CD62L+ T cell subset that represents central memory T cells, were increased in the rectum of patients with ulcerative colitis. In addition, the CD56+/CD3+ subset (natural killer T cells) was decreased in the rectum compared to that of less inflamed colonic mucosa. These results suggest that the enrichment of central memory T lymphocytes and the reduction of natural killer T cells in the gut mucosa are involved in the pathogenesis of ulcerative colitis.

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  • Clinical utility of a serum glycome analysis in patients with colorectal cancer Reviewed International journal

    Takei D, Harada K, Nouso K, MiyaharaK, Dohi C, Matsushita H, Kinugasa H, Hiraoka S, Nishimura S-I, Okada H

    J. Gastroen. Hepatol.   37 ( 4 )   727 - 733   2022

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    BACKGROUND AND AIM: Serum glycans are known to be good markers for the early diagnosis and prognostic prediction in many cancers. The aims of this study were to reveal the serum glycan changes comprehensively during the process of carcinogenesis from colorectal adenoma (CRA) to colorectal cancer (CRC) and to evaluate the usefulness of the glycan profiles as clinical markers for CRC. METHODS: Serum samples were obtained from 80 histologically proven CRC and 36 CRA cases. The levels of glycans in the serum were examined with a comprehensive, quantitative, high-throughput unique glycome analysis, and their diagnostic and prognostic abilities were evaluated. RESULTS: Among 34 stably detected glycans, nine were differentially expressed between CRC and CRA. Serum levels of hybrid type glycans were increased in patients with CRC compared with those with CRA (P < 0.001), and both hybrid-type and multi-antennary glycans were significantly increased in advanced cancer cases. The glycan, m/z 1914, showed the highest diagnostic value among the decreased glycans, whereas m/z 1708 showed the highest among the increased glycans. The glycan ratio m/z 1708/1914 showed a higher area under the receiver operating characteristic curve (0.889) than any other single glycan or conventional tumor marker, such as carcinoembryonic antigen (0.766, P = 0.040) and carbohydrate antigen 19-9 (0.615, P < 0.001). High m/z 1708/1914 was also correlated with an advanced cancer stage and short overall survival. CONCLUSION: Serum glycans, especially the m/z 1708/1914 ratio, were useful for the diagnosis, staging, and prognosis prediction of CRC.

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  • A nationwide survey concerning the mortality and risk of progressing severity due to arterial and venous thromboembolism in inflammatory bowel disease in Japan.

    Katsuyoshi Ando, Mikihiro Fujiya, Kenji Watanabe, Sakiko Hiraoka, Hisashi Shiga, Shinji Tanaka, Hideki Iijima, Tsunekazu Mizushima, Taku Kobayashi, Masakazu Nagahori, Hiroki Ikeuchi, Shingo Kato, Takehiro Torisu, Kiyonori Kobayashi, Masaaki Higashiyama, Toshiro Fukui, Takashi Kagaya, Motohiro Esaki, Shunichi Yanai, Daiki Abukawa, Makoto Naganuma, Satoshi Motoya, Masayuki Saruta, Shigeki Bamba, Makoto Sasaki, Kazuhiko Uchiyama, Katsuyuki Fukuda, Hideo Suzuki, Hiroshi Nakase, Toshiaki Shimizu, Masahiro Iizuka, Mamoru Watanabe, Yasuo Suzuki, Tadakazu Hisamatsu

    Journal of gastroenterology   56 ( 12 )   1062 - 1079   2021.12

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    BACKGROUND: The mortality and risk factors of severe disease and death due to arterial and venous thromboembolism (ATE and VTE, respectively) in patients with inflammatory bowel disease (IBD) remain unclear, especially in Asia. AIMS: This study aimed to reveal the mortality and risk factors of TE in IBD patients in Japan. METHODS: In the primary surveillance, responses to questionnaires regarding the number of cases of severe TE and TE-associated death in IBD patients in a span of over the past 10 years were obtained from 32 institutions in Japan. In the secondary surveillance, detailed data about IBD patients with TE were collected. The characteristics, laboratory data, therapy status, and situation at the time of TE development were retrospectively collected, and the data were compared between the patients with and without severe TE and TE-associated death. RESULTS: The incidence of TE was 1.89% among 31,940 IBD patients. The frequencies of severe TE and TE-associated mortality were 10.7% and 1.0% among the total IBD and TE with IBD patients, respectively. The only risk factor for severe ATE and ATE-associated death was ischemic heart disease. The independent risk factors for severe VTE and VTE-associated death were age (≤ 45 years old), the site of VTE, and disease severity, with anti-TNF therapy as a potential negative risk factor. Patients with severe VTE had a high risk of developing persistent VTE and sequelae. CONCLUSION: Unlike ATE, the incidence of VTE was comparable in Asian and Western countries. Therapeutic and prophylactic strategies for managing IBD-associated TE in Asia are urgently needed.

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  • Active and passive smoking and risk of ulcerative colitis: A case-control study in Japan. International journal

    Atsushi Nishikawa, Keiko Tanaka, Yoshihiro Miyake, Chisato Nagata, Shinya Furukawa, Akira Andoh, Tetsuji Yokoyama, Naoki Yoshimura, Kenichiro Mori, Tomoyuki Ninomiya, Yasunori Yamamoto, Eiji Takeshita, Yoshio Ikeda, Mitsuru Saito, Katsuhisa Ohashi, Hirotsugu Imaeda, Kazuki Kakimoto, Kazuhide Higuchi, Hiroaki Nunoi, Yuji Mizukami, Seiyuu Suzuki, Sakiko Hiraoka, Hiroyuki Okada, Keitarou Kawasaki, Masaaki Higashiyama, Ryota Hokari, Hiromasa Miura, Teruki Miyake, Teru Kumagi, Hiromasa Kato, Naohito Hato, Koji Sayama, Yoichi Hiasa

    Journal of gastroenterology and hepatology   37 ( 4 )   653 - 659   2021.11

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    BACKGROUND AND AIM: Although an inverse relationship between current smoking and the development of ulcerative colitis (UC) has been shown in North America and Europe, evidence is limited in Asian countries, where the incidence of UC is rapidly increasing. This Japanese case-control study examined the association between active and passive smoking and risk of UC. METHODS: A self-administered questionnaire was used to obtain information on smoking and potential confounding factors in 384 cases with a diagnosis of UC within the past 4 years and 665 controls. RESULTS: Compared with having never smoked, having ever smoked was associated with an increased risk of UC (adjusted odds ratio [OR] = 1.70, 95% confidence interval [CI]: 1.23-2.37). No association was observed between current smoking and risk of UC, but former smokers had a significant elevation in risk (adjusted OR = 2.40, 95% CI: 1.67-3.45). There was a positive dose-response relationship with pack-years smoked (P for trend = 0.006). Among never smokers, passive smoking exposure at home was significantly associated with an increased risk of UC (adjusted OR = 1.90, 95% CI: 1.30-2.79). A significant dose-response gradient was also observed between pack-years of passive smoking at home and risk of UC (P for trend = 0.0003). CONCLUSIONS: We confirmed that former smoking elevated the risk of UC, whereas an inverse association between current smoking and the risk of UC did not reach a statistically significant level. Passive smoking may be associated with an increased risk of UC.

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  • Evaluation of complete cold forceps polypectomy resection rate for 3- to 5-mm colorectal polyps. International journal

    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   2021.9

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    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).

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  • A novel clip closure method using precutting and a reopenable clip after colorectal endoscopic submucosal dissection. International journal

    Masayasu Ohmori, Yasushi Yamasaki, Shumpei Yamamoto, Hideaki Kinugasa, Keita Harada, Sakiko Hiraoka, Hiroyuki Okada

    Endoscopy   54 ( 8 )   E401-E402   2021.8

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  • Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitis. International journal

    Yuki Aoyama, Tomoki Inaba, Sakuma Takahashi, Hisae Yasuhara, Sakiko Hiraoka, Takeshi Morimoto, Hugh Shunsuke Colvin, Masaki Wato, Midori Ando, Satoko Nakamura, Koichi Mizobuchi, Hiroyuki Okada

    BMC gastroenterology   21 ( 1 )   325 - 325   2021.8

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    BACKGROUND: Serum anti-proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) is a disease-specific antibody against granulomatosis with polyangiitis. PR3-ANCA is a useful serological marker for disease severity in ulcerative colitis (UC). The purpose of this study was to investigate whether PR3-ANCA levels could also predict the success of induction therapy and to compare its performance against other markers, including serum CRP and fecal hemoglobin. METHODS: This was a multicenter retrospective study. In total, 159 patients with active-phase UC underwent colonoscopy. Disease activity was measured using the Mayo endoscopic subscore (MES). PR3-ANCA positivity and the response to induction therapy, either 5-aminosalicylic acid or steroid, were assessed. PR3-ANCA, CRP, and fecal hemoglobin were measured during the active phase, and during clinical remission. RESULTS: Eighty-five (53.5%) of 159 patients with active UC were positive for PR3-ANCA. PR3-ANCA titers were significantly higher in the group of patients with MES 3 compared to patients with MES 1 (P = 0.002) or MES 2 (P = 0.035). Steroid therapy was administered to 56 patients with a median partial Mayo score of 7 (5-9), which is equivalent to moderate-to-severe disease activity. PR3-ANCA positivity of non-responders to steroid therapy was significantly higher than that of responders (71.9% vs, 41.7%, P = 0.030), whereas CRP and fecal hemoglobin were not predictive of steroid response. Multivariate analysis demonstrated that PR3-ANCA positivity was associated with non-response to steroid therapy (odds ratio 5.19; 95% confidence interval, 1.54-17.5; P = 0.008). Of the 37 patients treated to clinical remission who were also positive for PR3-ANCA during the active phase, 27 had an MES of ≥ 1, and 10 patients had an MES of 0. In clinical remission, the proportion of patients with MES 0 in 17 patients whose PR3-ANCA became negative was significantly higher than that in 20 patients whose PR3-ANCA remained positive (47.1% vs. 10.0%, P = 0.023). CONCLUSIONS: PR3-ANCA not only serves as a marker of disease activity, but also predicts the failure of steroid therapy in moderate-to-severe UC. TRIAL REGISTRATION: This study was retrospectively registered in the UMIN Clinical Trials Registry System (000039174) on January 16, 2020.

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  • Concomitant use of an immunomodulator with ustekinumab as an induction therapy for Crohn's disease: A systematic review and meta-analysis. International journal

    Takeo Yoshihara, Shinichiro Shinzaki, Takahiro Amano, Hideki Iijima, Tetsuo Takehara, Nagamu Inoue, Motoi Uchino, Motohiro Esaki, Taku Kobayashi, Masayuki Saruta, Ken Sugimoto, Shiro Nakamura, Keisuke Hata, Fumihito Hirai, Sakiko Hiraoka, Toshimitsu Fujii, Minoru Matsuura, Katsuyoshi Matsuoka, Kenji Watanabe, Hiroshi Nakase, Mamoru Watanabe

    Journal of gastroenterology and hepatology   36 ( 7 )   1744 - 1753   2021.7

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    Background and aim: Ustekinumab (UST), a fully humanized monoclonal antibody against the p40 subunit of interleukin-12/23, is effective for the treatment of Crohn's disease (CD). The benefit of concomitant use of an immunomodulator (IM) with UST, however, is unclear. This study aimed to provide a systematic review and meta-analysis comparing the efficacy and safety of concomitant use of an IM with UST as an induction therapy for CD patients. Methods: A systematic literature search was performed using PubMed/MEDLINE, the Cochrane Library, and the Japana Centra Revuo Medicina from inception to October 31, 2019. The main outcome measure was achievement of clinical efficacy (remission, response, and clinical benefit) at 6–12 weeks. The quality of the included studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tools. The fixed-effects model was used to calculate the pooled odds ratios. Results: From 189 yielded articles, six including a total of 1507 patients were considered in this meta-analysis. Concomitant use of an IM with UST was significantly effective than UST monotherapy as an induction therapy (pooled odds ratio in the fixed-effects model: 1.35, 95% confidence interval [1.06–1.71], P = 0.015). The heterogeneity among studies was low (I2 = 2.6%). No statistical comparisons of the occurrence of adverse events between UST monotherapy and concomitant use of an IM with UST were performed. Conclusion: The efficacy of concomitant use of an IM with UST as an induction therapy for CD was significantly superior to that of monotherapy with UST.

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  • Heterogeneous distribution of Fusobacterium nucleatum in the progression of colorectal cancer. International journal

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

    Journal of gastroenterology and hepatology   36 ( 7 )   1869 - 1876   2021.7

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    BACKGROUND AND AIM: Fusobacterium nucleatum (Fn) is involved in colorectal cancer (CRC) growth and is a biomarker for patient prognosis and management. However, the ecology of Fn in CRC and the distribution of intratumoral Fn are unknown. METHODS: We evaluated Fn and the status of KRAS and BRAF in 200 colorectal neoplasms (118 adenomas and 82 cancers) and 149 matched adjacent normal mucosas. The differentiation status between "surface" and "deep" areas of cancer tissue and matched normal mucosa were analyzed in 46 surgical samples; the Ki-67 index was also evaluated in these samples. RESULTS: Fusobacterium nucleatum presence in the tumor increased according to pathological stage (5.9% [adenoma] to 81.8% [stage III/IV]), while Fn presence in normal mucosa also increased (7.6% [adenoma] to 40.9% [stage III/IV]). The detection rates of Fn on the tumor surface and in deep areas were 45.7% and 32.6%, while that of normal mucosa were 26.1% and 23.9%, respectively. Stage III/IV tumors showed high Fn surface area expression (66.7%). Fn intratumoral heterogeneity (34.8%) was higher than that of KRAS (4.3%; P < 0.001) and BRAF (2.2%; P < 0.001). The Ki-67 index in Fn-positive cases was higher than that in negative cases (93.9% vs 89.0%; P = 0.01). CONCLUSIONS: Fusobacterium nucleatum was strongly present in CRC superficial areas at stage III/IV. The presence of Fn in the deep areas of adjacent normal mucosa also increased. The intratumoral heterogeneity of Fn is important in the use of Fn as a biomarker, as Fn is associated with CRC proliferative capacity.

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  • Two Cases of Endometriosis in the Cecum Detected by Contrast-enhanced Computed Tomography with Air/Carbon Dioxide Insufflation.

    Masaya Iwamuro, Takehiro Tanaka, Yuusaku Sugihara, Keita Harada, Sakiko Hiraoka, Yoshitaka Kondo, Hiroyuki Okada

    Internal medicine (Tokyo, Japan)   60 ( 11 )   1697 - 1701   2021.6

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    We herein report two patients with endometriosis in the cecum. Both patients presented with a protruding, subepithelial tumor on colonoscopy and were diagnosed with cecal endometriosis after surgical resection. It is notable that the cecal lesions were not initially identified on computed tomography (CT), while CT colonography with air/carbon dioxide insufflation resulted in the detection of the cecal tumor. These cases highlight the possibility of false-negative results on conventional CT in patients with cecal endometriosis. We consider CT colonography with air/carbon dioxide insufflation useful for detecting cecal tumors in such cases.

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  • Leucine-rich alpha-2 glycoprotein is a potential biomarker to monitor disease activity in inflammatory bowel disease receiving adalimumab: PLANET study.

    Shinichiro Shinzaki, Katsuyoshi Matsuoka, Hiroki Tanaka, Fuminao Takeshima, Shingo Kato, Takehiro Torisu, Yuki Ohta, Kenji Watanabe, Shiro Nakamura, Naoki Yoshimura, Taku Kobayashi, Akiko Shiotani, Fumihito Hirai, Sakiko Hiraoka, Mamoru Watanabe, Minoru Matsuura, Shohei Nishimoto, Shinta Mizuno, Hideki Iijima, Tetsuo Takehara, Tetsuji Naka, Takanori Kanai, Takayuki Matsumoto

    Journal of gastroenterology   56 ( 6 )   560 - 569   2021.6

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    BACKGROUND: This multicenter prospective study (UMIN000019958) aimed to evaluate the usefulness of serum leucin-rich alpha-2 glycoprotein (LRG) levels in monitoring disease activity in inflammatory bowel disease (IBD). METHODS: Patients with moderate-to-severe IBD initiated on adalimumab therapy were enrolled herein. Serum LRG, C-reactive protein (CRP), and fecal calprotectin (fCal) levels were measured at week 0, 12, 24, and 52. Colonoscopy was performed at week 0, 12, and 52 for ulcerative colitis (UC), and at week 0, 24, and 52 for Crohn's disease (CD). Endoscopic activity was assessed using the Simple Endoscopic Score for Crohn's Disease (SES-CD) for CD and the Mayo endoscopic subscore (MES) for UC. RESULTS: A total of 81 patients was enrolled. Serum LRG levels decreased along with improvements in clinical and endoscopic outcomes upon adalimumab treatment (27.4 ± 12.6 μg/ml at week 0, 15.5 ± 7.7 μg/ml at week 12, 15.7 ± 9.6 μg/ml at week 24, and 14.5 ± 6.8 μg/ml at week 52), being correlated with endoscopic activity at each time point (SES-CD: r = 0.391 at week 0, r = 0.563 at week 24, r = 0.697 at week 52; MES: r = 0.534 at week 0, r = 0.429 at week 12, r = 0.335 at week 52). Endoscopic activity better correlated with LRG compared to CRP and fCal on pooled analysis at all time points (SES-CD: LRG: r = 0.636, CRP: r = 0.402, fCal: r = 0.435; MES: LRG: r = 0.568, CRP: 0.389, fCal: r = 0.426). CONCLUSIONS: Serum LRG is a useful biomarker of endoscopic activity both in CD and UC during the adalimumab treatment.

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  • 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   2021.6

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    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)

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  • Does anti-tumor necrosis factor alpha prevent the recurrence of Crohn's disease? Systematic review and meta-analysis. International journal

    Motoi Uchino, Hiroki Ikeuchi, Keisuke Hata, Tomohiro Minagawa, Yuki Horio, Ryuichi Kuwahara, Shiro Nakamura, Kenji Watanabe, Masayuki Saruta, Toshimitsu Fujii, Taku Kobayashi, Ken Sugimoto, Fumihito Hirai, Motohiro Esaki, Sakiko Hiraoka, Katsuyoshi Matsuoka, Shinichiro Shinzaki, Minoru Matsuura, Nagamu Inoue, Hiroshi Nakase, Mamoru Watanabe

    Journal of gastroenterology and hepatology   36 ( 4 )   864 - 872   2021.4

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    BACKGROUND AND AIM: Anti-tumor necrosis factor (TNF) α agents are now well known to function as effective treatments for Crohn's disease (CD). Several meta-analyses have revealed the efficacy of anti-TNF therapy for preventing recurrence after surgery; however, the efficacies reported in some prospective studies differed according to the outcomes. Moreover, adverse events (AEs) were not well evaluated. We conducted this systematic review and meta-analysis to evaluate both the efficacy of anti-TNF therapy after stratification by the outcome of interest and the AEs. METHODS: We performed a systematic literature review of studies investigating anti-TNF therapy, CD, and postoperative recurrence. Meta-analyses were performed for endoscopic and clinical recurrence and AEs. RESULTS: A total of 570 participants, including 254 patients in the intervention group and 316 patients in the control group, in eight studies, were analyzed for recurrence. Based on the results of the meta-analysis, the efficacies of anti-TNF therapy at preventing endoscopic and clinical recurrence were as follows: relative risk (RR) 0.34, 95% confidence interval (CI) 0.22-0.53 and RR 0.60, 95% CI 0.36-1.02, respectively. The RR of AEs with anti-TNF therapy was 1.75 (95% CI 0.81-3.79). CONCLUSIONS: Anti-TNF therapy after surgery for CD displays efficacy at preventing endoscopic recurrence for 1-2 years, without increasing the incidence of AEs. However, clinical recurrence was not significantly reduced. The efficacy of postoperative anti-TNF therapy may differ in terms of the outcomes, which include long-term prevention, the avoidance of further surgery, and cost-effectiveness.

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  • 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   2021.4

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  • Intestinal cancer in patients with Crohn's disease: A systematic review and meta-analysis. International journal

    Motoi Uchino, Hiroki Ikeuchi, Keisuke Hata, Tomohiro Minagawa, Yuki Horio, Ryuichi Kuwahara, Shiro Nakamura, Kenji Watanabe, Masayuki Saruta, Toshimitsu Fujii, Taku Kobayashi, Ken Sugimoto, Fumihito Hirai, Motohiro Esaki, Sakiko Hiraoka, Katsuyoshi Matsuoka, Shinichiro Shinzaki, Minoru Matsuura, Nagamu Inoue, Hiroshi Nakase, Mamoru Watanabe

    Journal of gastroenterology and hepatology   36 ( 2 )   329 - 336   2021.2

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    BACKGROUND AND AIM: Although surveillance colonoscopy is recommended by several guidelines for Crohn's disease (CD), the evidence is insufficient to support the validity of this recommendation. Moreover, the efficacy of surveillance colonoscopy for anorectal cancer remains unclear. Therefore, we performed a systematic review of cancer in patients with CD before considering the proper surveillance methods. METHODS: We conducted a systematic review and meta-analysis examining the incidence of intestinal cancer and a literature review to clarify the characteristic features of cancer in CD. We performed the systematic literature review of studies published up to May 2019. RESULTS: Overall, 7344 patients were included in eight studies. The standardized incidence ratios (95% confidence intervals) of colorectal cancer (CRC) and small bowel cancer (SBC) were 2.08 (1.43-3.02) and 22.01 (9.10-53.25), respectively. The prevalence of CRC and SBC was 57/7344 (0.77%) and 17/7344 (0.23%), respectively, during a median follow-up of 12.55 years. Additionally, 54 studies reporting 208 anorectal cancer cases were identified. In patients with anorectal cancer, the prognosis for survival was 2.1 ± 2.3 years, and advanced cancer greater than stage T3 occurred in 46/74 patients (62.1%). Many more reports of anorectal cancer were published in Asia than in Western countries. CONCLUSION: Although we were unable to state a recommendation for surveillance for SBC, we should perform cancer surveillance for CRC in patients with CD. However, the characteristics of cancer may differ according to geography or race. We must establish proper and effective surveillance methods that are independently suitable to detect these differences.

    DOI: 10.1111/jgh.15229

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    Other Link: https://onlinelibrary.wiley.com/doi/full-xml/10.1111/jgh.15229

  • Genetic Background of Mesalamine-induced Fever and Diarrhea in Japanese Patients with Inflammatory Bowel Disease. International journal

    Kaoru Suzuki, Yoichi Kakuta, Takeo Naito, Tetsuya Takagawa, Hiroyuki Hanai, Hiroshi Araki, Yu Sasaki, Hirotake Sakuraba, Makoto Sasaki, Tadakazu Hisamatsu, Satoshi Motoya, Takayuki Matsumoto, Motoyuki Onodera, Yoh Ishiguro, Hiroshi Nakase, Akira Andoh, Sakiko Hiraoka, Masaru Shinozaki, Toshimitsu Fujii, Takehiko Katsurada, Taku Kobayashi, Mikihiro Fujiya, Takafumi Otsuka, Naoki Oshima, Yasuo Suzuki, Yuichirou Sato, Ryota Hokari, Mitsunori Noguchi, Yuki Ohta, Minoru Matsuura, Yosuke Kawai, Katsushi Tokunaga, Masao Nagasaki, Hisaaki Kudo, Naoko Minegishi, Daisuke Okamoto, Yusuke Shimoyama, Rintaro Moroi, Masatake Kuroha, Hisashi Shiga, Dalin Li, Dermot P B McGovern, Yoshitaka Kinouchi, Atsushi Masamune

    Inflammatory bowel diseases   28 ( 1 )   21 - 31   2021.1

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    BACKGROUND: Some patients with inflammatory bowel disease (IBD) who were under mesalamine treatment develop adverse reactions called "mesalamine allergy," which includes high fever and worsening diarrhea. Currently, there is no method to predict mesalamine allergy. Pharmacogenomic approaches may help identify these patients. Here we analyzed the genetic background of mesalamine intolerance in the first genome-wide association study of Japanese patients with IBD. METHODS: Two independent pharmacogenetic IBD cohorts were analyzed: the MENDEL (n = 1523; as a discovery set) and the Tohoku (n = 788; as a replication set) cohorts. Genome-wide association studies were performed in each population, followed by a meta-analysis. In addition, we constructed a polygenic risk score model and combined genetic and clinical factors to model mesalamine intolerance. RESULTS: In the combined cohort, mesalamine-induced fever and/or diarrhea was significantly more frequent in ulcerative colitis vs Crohn's disease. The genome-wide association studies and meta-analysis identified one significant association between rs144384547 (upstream of RGS17) and mesalamine-induced fever and diarrhea (P = 7.21e-09; odds ratio = 11.2). The estimated heritability of mesalamine allergy was 25.4%, suggesting a significant correlation with the genetic background. Furthermore, a polygenic risk score model was built to predict mesalamine allergy (P = 2.95e-2). The combined genetic/clinical prediction model yielded a higher area under the curve than did the polygenic risk score or clinical model alone (area under the curve, 0.89; sensitivity, 71.4%; specificity, 90.8%). CONCLUSIONS: Mesalamine allergy was more common in ulcerative colitis than in Crohn's disease. We identified a novel genetic association with and developed a combined clinical/genetic model for this adverse event.

    DOI: 10.1093/ibd/izab004

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  • Histologic Transformation from Follicular Lymphoma to Diffuse Large B-cell Lymphoma Detected during Colonoscopy.

    Masaya Iwamuro, Yasushi Yamasaki, Takehiro Tanaka, Noboru Asada, Ken-Ichi Matsuoka, Sakiko Hiraoka, Yoshiro Kawahara, Hiroyuki Okada

    Acta medica Okayama   75 ( 5 )   625 - 629   2021

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    A 77-year-old Japanese woman who had been treated for follicular lymphoma for 8 years developed abdominal pain and intra-abdominal lymphadenopathies. Colonoscopy revealed an elevated lesion in the rectum, which presented as two humps with erosions. A diagnosis of histologic transformation of follicular lymphoma to diffuse large B-cell lymphoma was made by endoscopic biopsy. This case underscores the importance of endoscopy examinations and biopsy of newly emerged gastrointestinal lesions for the prompt diagnosis of histologic transformation, since salvage chemotherapy must be initiated quickly in such cases.

    DOI: 10.18926/AMO/62775

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  • Dietary intake of vegetables, fruit, and antioxidants and risk of ulcerative colitis: A case-control study in Japan. International journal

    Yoshihiro Miyake, Keiko Tanaka, Chisato Nagata, Shinya Furukawa, Akira Andoh, Tetsuji Yokoyama, Naoki Yoshimura, Kenichiro Mori, Tomoyuki Ninomiya, Yasunori Yamamoto, Eiji Takeshita, Yoshio Ikeda, Mitsuru Saito, Katsuhisa Ohashi, Hirotsugu Imaeda, Kazuki Kakimoto, Kazuhide Higuchi, Hiroaki Nunoi, Yuji Mizukami, Seiyuu Suzuki, Sakiko Hiraoka, Hiroyuki Okada, Keitarou Kawasaki, Masaaki Higashiyama, Ryota Hokari, Hiromasa Miura, Teruki Miyake, Teru Kumagi, Hiromasa Kato, Naohito Hato, Koji Sayama, Yoichi Hiasa

    Nutrition (Burbank, Los Angeles County, Calif.)   91-92   111378 - 111378   2021

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    OBJECTIVES: Oxidative stress is considered one of the etiologic factors involved in ulcerative colitis (UC), yet there is limited epidemiologic information regarding the relationship between antioxidant intake and the risk of UC. The aim of the present case-control study in Japan was to examine the association between intake of green and yellow vegetables, other vegetables, fruit, vitamin C, vitamin E, retinol, alpha-carotene, beta-carotene, and cryptoxanthin and UC risk. METHODS: A total of 384 cases within 4 y of diagnosis with UC and 665 controls were included in the study. Data on dietary intake and confounders were obtained using a self-reported questionnaire. Information on dietary factors was collected using a 169-item semiquantitative food-frequency questionnaire. Adjustment was made for sex, age, pack-y of smoking, alcohol consumption, history of appendicitis, family history of UC, education level, and body mass index. RESULTS: Higher intake levels of other vegetables, vitamin C, and retinol were independently associated with a reduced risk of UC. The adjusted odds ratio between extreme quartiles was 0.51 (95% confidence interval [CI], 0.34-0.76; P for trend ≤ 0.001) for other vegetables, 0.45 (95% CI, 0.30-0.69, P for trend ≤ 0.001) for vitamin C, and 0.64 (95% CI, 0.43-0.95, P for trend = 0.04) for retinol. There were no associations between intake of green and yellow vegetables, fruit, vitamin E, alpha-carotene, beta-carotene, or cryptoxanthin and UC risk (P for trend = 0.29, 0.56, 0.89, 0.20, 0.69, and 0.22, respectively). CONCLUSIONS: Intake of other vegetables, vitamin C, and retinol was inversely associated with UC risk.

    DOI: 10.1016/j.nut.2021.111378

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  • 憩室内に形成された大腸肉芽性ポリープの3例

    岩室 雅也, 田中 健大, 都地 友紘, 山本 峻平, 平井 麻美, 岡 昌平, 平岡 佐規子, 河原 祥朗, 岡田 裕之

    Gastroenterological Endoscopy   62 ( 12 )   3057 - 3063   2020.12

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    大腸肉芽性ポリープは術後の吻合部や内視鏡治療後の創にみられることが多く,憩室に関連して発生した肉芽性ポリープの報告は少ない.今回筆者らは憩室関連肉芽性ポリープの3例を経験したので報告した.3例ともにS状結腸に憩室内から突出する発赤調ポリープを呈し,表面に白色付着物と蛇行する毛細血管を伴っていた.また拡大観察で表面構造は不明瞭または消失といった特徴を有しており,生検により肉芽性ポリープと診断した.また,1例ではポジトロン断層法検査でポリープに集積を認めた.上記の内視鏡所見を認める場合は,憩室関連肉芽性ポリープを鑑別に挙げるべきと考えられた.(著者抄録)

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

    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   2020.8

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    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.

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  • 【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   2020.8

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    <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.

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  • Clinical Characteristics and Risk Factors for Rebleeding in Patients with Obscure Gastrointestinal Bleeding.

    Yuki Baba, Seiji Kawano, Yoshiyasu Kono, Toshihiro Inokuchi, Hiromitsu Kanzaki, Masaya Iwamuro, Keita Harada, Sakiko Hiraoka, Yoshiro Kawahara, Hiroyuki Okada

    Internal medicine (Tokyo, Japan)   59 ( 11 )   1345 - 1350   2020.6

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    Objective With the advent of capsule endoscopy (CE) and double-balloon endoscopy (DBE), the diagnosis and treatment of obscure gastrointestinal bleeding (OGIB) have markedly progressed. However, rebleeding sometimes occurs and is difficult to diagnose and treat. The aim of the present study was to investigate the clinical features of OGIB and risk factors for rebleeding in our hospital. Methods A total of 195 patients who underwent CE and/or DBE for OGIB in our hospital from January 2009 to July 2016 were included in the present study. We analyzed 168 cases of small intestinal OGIB, after excluding 27 cases of extra small intestinal bleeding. The clinical characteristics and risk factors related to rebleeding were retrospectively studied. Results Among the 168 patients who were included in the analysis, 95 patients (56.5%) were male. The mean age was 64.5 years (range, 8 to 87 years). Hypertension (31.0%) was the most frequent comorbidity, followed by chronic kidney disease (19.0%). The final diagnoses were ulcerative lesions (n=50, 29.8%), vascular lesions (n=30, 17.9%), tumors (n=7, 4.2%), and diverticula (n=2, 1.2%). The bleeding source was undetermined in the remaining 79 cases (47.0%). Rebleeding was confirmed in 29 cases (17.3%). In a univariate analysis, chronic kidney disease, vascular lesions, and overt previous bleeding were significantly associated with the risk of rebleeding. A multivariate analysis showed that chronic kidney disease, vascular lesion, and overt previous bleeding were significantly associated with the risk of rebleeding. Conclusion Patients with OGIB with overt previous bleeding, vascular lesions, and/or chronic kidney disease had a higher risk of rebleeding.

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  • 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   2020.5

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  • Observer agreement for the diagnosis of intestinal acute graft-vs.-host disease based on the presence of villous atrophy in the terminal ileum. International journal

    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   2020.4

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    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).

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  • Cytomegalovirus Colitis Followed by Colonic Pseudolipomatosis and Gastric Emphysema in a Post-resuscitation Patient. Reviewed

    Masaya Iwamuro, Takehiro Tanaka, Nao Yamauchi, Yuri Nakashima, Takahira Wada, Sakiko Hiraoka, Yoshiro Kawahara, Hiroyuki Okada

    Internal medicine (Tokyo, Japan)   59 ( 4 )   519 - 525   2020.2

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    A 64-year-old Japanese man suffered cardiopulmonary arrest, which may have resulted from sepsis and/or hyperosmolar hyperglycemic non-ketonic coma, and was admitted after successful resuscitation. He had watery diarrhea on day 18 and was diagnosed with cytomegalovirus enterocolitis. In addition, computed tomography performed on day 27 and colonoscopy revealed gastric emphysema and intestinal pseudolipomatosis, respectively. This report is the first to describe a patient with cytomegalovirus enterocolitis and subsequent gastric emphysema and pseudolipomatosis. Gastrointestinal cytomegalovirus infection may underlie gastric emphysema and intestinal pseudolipomatosis, particularly in patients with relative or obvious immune dysfunction.

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  • 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   2020.2

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  • Appendiceal Orifice Inflammation in Ulcerative Colitis Mimicking Mucosa-Associated Lymphoid Tissue Lymphoma in the Cecum. International journal

    Masaya Iwamuro, Takahide Takahashi, Takehiro Tanaka, Tomohiro Toji, Sakiko Hiraoka, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

    Case reports in gastrointestinal medicine   2020   8893604 - 8893604   2020

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    A 55-year-old Japanese woman, who had been diagnosed with ulcerative colitis at 18 years of age, underwent screening endoscopy examinations. Esophagogastroduodenoscopy revealed an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) of the stomach. Colonoscopy showed a slightly elevated reddish lesion with dilated microvessels but no erosions or ulcers. Although MALT lymphoma in the cecum was endoscopically suspected, flow cytometry and pathological analyses led to the diagnosis of appendiceal orifice inflammation in ulcerative colitis. This case highlights the diversity of the endoscopic appearance of appendiceal orifice inflammation in ulcerative colitis.

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  • A Granulation Polyp in the Colon Masquerading as Metastatic Cancer. Reviewed

    Masaya Iwamuro, Masahiro Takahara, Tatsuhiro Yamazaki, Takehiro Tanaka, Yoshitaka Kondo, Sakiko Hiraoka, Hiroyuki Okada

    Acta medica Okayama   73 ( 5 )   457 - 461   2019.10

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    A 60-year-old Caucasian male was diagnosed with lung adenocarcinoma and multiple metastases to the bone, spleen, and brain. He underwent radiotherapy for the brain and lumbar spine metastases, plus chemotherapy (cisplatin and pemetrexed). The chemotherapy was discontinued due to vomiting and hyponatremia, and nivolumab was then administered. Eight months later, 18F-fluorodeoxyglucose positron emission tomography showed tracer uptake in the colon. Colonoscopy revealed a reddish multinodular polyp in the sigmoid colon. The polyp showed irregular microvessels. No colonic mucosal surface structures were observed. Colonic metastasis of the lung carcinoma was highly suspected; the polyp was therefore surgically removed. The histological analysis revealed granulation tissue and suppurative inflammation without neoplastic changes. We diagnosed the lesion as a granulation polyp. Despite the difficulty in diagnosing these lesions due to their rarity and similarity to metastatic colon tumors, we suggest that recognizing the endoscopic features of the polyp surface may allow a preoperative diagnosis.

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  • Paradoxical Roles of Oxidative Stress Response in the Digestive System before and after Carcinogenesis. Reviewed International journal

    Akinobu Takaki, Seiji Kawano, Daisuke Uchida, Masahiro Takahara, Sakiko Hiraoka, Hiroyuki Okada

    Cancers   11 ( 2 )   2019.2

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    Oxidative stress is recognized as a cancer-initiating stress response in the digestive system. It is produced through mitochondrial respiration and induces DNA damage, resulting in cancer cell transformation. However, recent findings indicate that oxidative stress is also a necessary anticancer response for destroying cancer cells. The oxidative stress response has also been reported to be an important step in increasing the anticancer response of newly developed molecular targeted agents. Oxidative stress might therefore be a cancer-initiating response that should be downregulated in the precancerous stage in patients at risk of cancer but an anticancer cell response that should not be downregulated in the postcancerous stage when cancer cells are still present. Many commercial antioxidant agents are marketed as "cancer-eliminating agents" or as products to improve one's health, so cancer patients often take these antioxidant agents. However, care should be taken to avoid harming the anticancerous oxidative stress response. In this review, we will highlight the paradoxical effects of oxidative stress and antioxidant agents in the digestive system before and after carcinogenesis.

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

    Yuusaku Sugihara, Keita Harada, Shohei Oka, Eriko Yasutomi, Yasushi Yamasaki, Toshihiro Inokuchi, Hideaki Kinugasa, Masahiro Takahara, Sakiko Hiraoka, Fumio Otsuka, Hiroyuki Okada

    Acta medica Okayama   73 ( 1 )   81 - 84   2019.2

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    Endoscopic submucosal dissection (ESD) is reportedly one of the standard treatment strategies for large superficial colorectal neoplasms in Japan because of its high en bloc resection rate. A few technical issues regarding ESD should be considered, one of which is the selection of the Endo-cut I mode versus the Swift-coagulation mode as the electrosurgical unit mode setting during submucosal dissection. We seek to determine which of these two modes is more suitable for submucosal dissections of colorectal tumors with regard to procedure time and safety.

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  • Lymphoproliferative disease in a patient with Takayasu arteritis and ulcerative colitis Reviewed

    Yosuke Asano, Ken-Ei Sada, Keigo Hayashi, Yuriko Yamamura, Sumie Hiramatsu, Keiji Ohashi, Yoshia Miyawaki, Michiko Morishita, Haruki Watanabe, Yoshinori Matsumoto, Tomoko Kawabata, Noriyuki Tanaka, Sakiko Hiraoka, Jun Wada

    Modern Rheumatology Case Reports   3 ( 1 )   34   2019.1

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    DOI: 10.1080/24725625.2018.1507271

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  • A Case of Diffuse Esophageal Spasm Treated with Peroral Endoscopic Myotomy. Reviewed

    Sugihara Y, Harada K, Kato R, Yamauchi K, Sakae H, Kawano S, Hiraoka S, Kawahara Y, Otsuka F, Okada H

    Acta medica Okayama   72 ( 6 )   595 - 600   2018.12

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    The indications for peroral endoscopic myotomy (POEM) have been expanded to include diffuse esophageal spasm (DES). A 67-year-old Japanese man presented with a 4-year history of dysphagia. Endoscopy and upper gastrography revealed abnormal peristaltic movements involving interruption of normal peristalsis, and a diverticulum located at the 2 o'clock esophageal position. High-resolution manometry indicated DES. POEM with a long (15 cm) myotomy was performed for the abnormal contractions, which subsequently disappeared along with dysphagia improvement. Our results suggest that esophageal motility disorders accompanying a diverticulum may be eliminated by POEM without treating the diverticulum itself. We speculate that POEM ameliorates esophageal diverticulum by reducing internal esophageal pressure.

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  • Pseudolipomatosis of the Colon and Cecum Followed by Pneumatosis Intestinalis. Reviewed

    Iwamuro M, Tanaka T, Kawabata T, Sugihara Y, Harada K, Hiraoka S, Okada H

    Internal medicine (Tokyo, Japan)   57 ( 17 )   2501 - 2504   2018.9

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    A 74-year-old Japanese woman was diagnosed with pseudolipomatosis of the cecum and ascending colon. Colonoscopy was performed, which revealed the presence of slightly elevated white lesions, while a magnifying observation showed microbubbles within the mucosa. A month after colonoscopy, the patient was diagnosed with pneumatosis intestinalis. Although the exact pathogenesis is unclear, pneumatosis intestinalis may arise secondary to pseudolipomatosis. This case also indicates that a magnifying observation during colonoscopy may aid in the diagnosis of pseudolipomatosis of the large intestine, since it shows microbubbles within the mucosa, which may be a distinctive feature reflecting the pathology of this disease.

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  • 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   2018.8

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    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。

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  • An Elevated Platelet Count Increases the Risk of Relapse in Ulcerative Colitis Patients with Mucosal Healing. Reviewed International journal

    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   2018.7

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    Background/Aims: Although mucosal healing (MH) has been considered a treatment goal for patients with ulcerative colitis (UC), the risk factors predictive of relapse in patients who achieve MH are unknown. Because the platelet count has been shown to be a marker of inflammation in inflammatory bowel diseases, this study aimed to assess whether the platelet count could predict relapse in UC patients with MH. Methods: A prospective observational study was performed. UC patients with MH were consecutively enrolled in the study and monitored for at least 2 years or until relapse. The correlation between the incidence of relapse and the platelet count at the time of study enrollment was examined. Results: In total, 43 patients were enrolled, and 14 patients (33%) relapsed. The median platelet count at the time of enrollment in the patients who relapsed significantly differed from that in the patients who did not relapse (27.2×10⁴/μL vs 23.8×10⁴/μL, respectively; p=0.016). A platelet count >25.0×10⁴/μL was a significant risk factor for relapse based on a multivariate analysis (hazard ratio, 4.85; 95% confidence interval, 1.07 to 25.28), and according to the Kaplan-Meier analysis, this cutoff could identify patients susceptible to relapse (p=0.041, log-rank test). Conclusions: The platelet count could be used as a predictor of relapse in UC patients with MH.

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  • 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. Reviewed International journal

    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   2018.7

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    BACKGROUND: Graft-versus-host disease (GVHD) is a common complication of allo-hematopoietic stem cell transplantation (allo-HSCT). Endoscopic biopsy can provide a definitive diagnosis, but the optimal endoscopic approach for diagnosis remains uncertain. This study evaluated whether ileocolonoscopic imaging can predict acute GVHD severity after allo-HSCT. METHODS: Consecutive patients who underwent allo-HSCT were referred to our institution, and those diagnosed with acute GVHD by pathology were included in this retrospective study. RESULTS: Fifty-one of 261 patients who underwent ileocolonoscopy were suspected to have acute intestinal GVHD. We performed univariate and multivariate conditional logistic regression with stepwise variable selection; villous atrophy in the terminal ileum remained a statistically significant predictor of GVHD severity (odds ratio, 4.69; 95% confidence interval, 1.07-20.60, P = 0.04). Patients were classified into three groups based on ileal endoscopic findings in the terminal ileum: group S, GVHD with severe villous atrophy; group M, mild atrophy; and group N, no atrophy. Compared with patients in groups M and N, those in group S had significant clinical GVHD at diagnosis (P = 0.03). In group S, three of four, compared with five of 13 patients in groups M and N, required the addition of second-line agents (P = 0.02). CONCLUSIONS: This study showed that severe atrophy of the terminal ileum predicts severe clinical GVHD that is likely to be refractory to steroid treatment. Thus, the severity of terminal ileum atrophy may serve as a tool in predicting clinically severe GVHD. TRIAL REGISTRATION: Trial Registration Number UMIN 000022805 , Registration date July 1, 2016.

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

    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   2018.4

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    Peroral endoscopic myotomy (POEM) for treatment of esophageal motility disorders has recently been reported to be highly effective and less invasive than other treatment. POEM was recently introduced in Okayama University Hospital under the supervision of a physician from a high-volume center. To verify the safety and efficacy of POEM during its introduction in our institution. We examined 10 cases in whom POEM was performed between January 2016 and April 2017. The patients included 7 men and 3 women, with a median age (range) of 49 years (17-74) and median symptom duration of 6 years (1-21). Seven patients had a straight esophagus, and the remaining 3 had a sigmoid esophagus. According to the Chicago classification, 6 patients were diagnosed with type I achalasia, 2 with type II achalasia, and 2 with distal esophagus spasm. Treatment outcomes and adverse events were evaluated. Treatment success was defined as a > 3 decrease in Eckardt score or a score of <3 at the time of discharge. The treatment success rate was 90%, with the average Eckardt score decreasing significantly, from 4.7 to 0.9 (p<0.05). No mucosal perforation, severe infection, mediastinitis, severe bleeding, or gastroesophageal reflux occurred intraoperatively or postoperatively. POEM was introduced to Okayama University Hospital, and the first 10 cases were accomplished safely and effectively under the supervision of an expert physician from a high-volume center.

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  • Evaluation of the Upper Gastrointestinal Tract in Ulcerative Colitis Patients. Reviewed

    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   2018.4

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    To analyze the clinical characteristics of patients with ulcerative colitis who have upper gastrointestinal lesions, we retrospectively reviewed the data of 216 patients with ulcerative colitis who underwent esophagogastroduodenoscopy at our institute in April 2008-March 2016. We investigated the endoscopic features and compared the clinical characteristics between the patients with and without upper gastrointestinal lesions. Forty-two patients (19.4%) had upper gastrointestinal lesions, including multiple erosions (n=18), bamboo joint-like appearance (n=17), mucosa with white spots (n=4), friable mucosa (n=2), ulcer (n=1), and purulent deposits within the mucosa (n=1) in the stomach and/or duodenum. Compared to the patients without upper gastrointestinal lesions, those with upper gastrointestinal lesions showed significantly more frequent extraintestinal manifestations (19.0% vs. 8.0%, p<0.05) and a significant history of colectomy (33.3% vs. 12.1%, p<0.01). There were no significant differences with regard to the sex ratio, age at esophagogastroduodenoscopy, gastrointestinal symptoms, time since the diagnosis of ulcerative colitis, type of colitis at the initial diagnosis of ulcerative colitis, or gastric atrophy between the groups. In conclusion, gastroduodenal lesions were identified in 19.4% of the patients with ulcerative colitis. Esophagogastroduodenoscopy is particularly recommended for ulcerative colitis patients who show extraintestinal manifestations and for those who have undergone a colectomy.

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  • 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   2018.2

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    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)

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  • Colonoscopy examination requires a longer time in patients with acromegaly than in other individuals Reviewed

    Masaya Iwamuro, Miho Yasuda, Kou Hasegawa, Satoshi Fujisawa, Kanako Ogura-Ochi, Yuusaku Sugihara, Keita Harada, Sakiko Hiraoka, Hiroyuki Okada, Fumio Otsuka

    Endocrine Journal   65 ( 2 )   151 - 157   2018

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    This study aimed to determine the prevalence of colorectal neoplasms and to investigate the rate of and time required for cecal intubation in patients with acromegaly. A database search performed at our institution identified 29 patients with acromegaly who underwent colonoscopy. Data regarding the endoscopic, biological, and pathological examinations performed were retrospectively reviewed from the clinical records. Subsequently, the rate of and time required for cecal intubation were investigated in 23 patients with acromegaly and compared with the corresponding data of the control group. Control subjects were selected from a 2:1 matched historical control cohort, according to baseline characteristics. The mean age of the acromegaly group (17 female and 12 male) was 60.4 ± 12.6 years. Twelve patients had adenoma (41.4%), eight patients had hyperplastic polyps (27.6%), three patients had sessile serrated adenoma/polyps (10.3%), and three patients had colon cancer (10.3%). Successful cecal intubation was achieved in all patients in both groups. The difference in the time required for successful intubation between the acromegaly group (15.7 ± 9.8 minutes) and the control group (8.7 ± 6.0 minutes) was statistically significant. Linear regression analysis revealed that increased patient age was significantly related to longer colonoscope insertion times. In conclusion, although cecal intubation during colonoscopy was successful in all participants, it required a longer time in patients with acromegaly. Our results underscore the importance of and certain technical difficulties involved in colonoscopy procedures in patients with acromegaly, especially in older patients.

    DOI: 10.1507/endocrj.EJ17-0322

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  • Two Cases of Leiomyoma in the Colon Masquerading as Other Types of Colonic Pedunculated Polyps. Reviewed International journal

    Ikeda A, Iwamuro M, Tanaka T, Inokuchi T, Nakarai A, Sugihara Y, Harada K, Hiraoka S, Kawahara Y, Okada H

    Case reports in gastrointestinal medicine   2018   8272313 - 8272313   2018

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    We describe two cases of leiomyoma in the colon that were diagnosed histologically after endoscopic resection. The first case was a 79-year-old Japanese woman who presented with a pedunculated polyp of 14 mm length at the splenic flexure. Preoperative diagnosis suggested a colonic mucosubmucosal elongated polyp. The second case was a 29-year-old Japanese woman who presented with a pedunculated polyp of 40 mm length at the hepatic flexure and had an ulcer on top of the polyp. Preoperative diagnosis suggested an inflammatory fibroid polyp. A pathological diagnosis of colonic leiomyoma was made after endoscopic resection in both cases. Both tumors were confirmed to originate, not from the proper muscle layer, but from the muscularis mucosae. These cases underscore that although colonic involvement is infrequent, leiomyomas can display pedunculated morphology in the colon rather than the typical gross appearance of gastrointestinal submucosal tumors seen with sessile morphology.

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  • Author's Reply Reviewed

    Sakiko Hiraoka, Jun Kato, Hiroyuki Okada

    Intestinal Research   16 ( 2 )   321 - 322   2018

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  • Usefulness of biomarkers for disease activity and mucosal healing in patients with inflammatory bowel disease Reviewed

    Sakiko Hiraoka, Jun Kato, Hiroyuki Okada

    Journal of Japanese Society of Gastroenterology   115 ( 3 )   262 - 271   2018

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

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

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

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    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.

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  • Metachronous Neoplasia and Local Recurrence after Colorectal Endoscopic Submucosal Dissection Reviewed

    Daisuke Takei, Keita Harada, Shiho Takashima, Toshihiro Inokuchi, Asuka Nakarai, Yusaku Sugihara, Masanobu Takahara, Sakiko Hiraoka, Hiroyuki Okada

    ACTA MEDICA OKAYAMA   71 ( 6 )   475 - 483   2017.12

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    Several reports discussed colonoscopic surveillance after polypectomy and endoscopic mucosal resection (EMR) for colorectal polyps, but only a few reports focused on prognostic analyses, and none involved meta-chronous neoplasia after colorectal endoscopic submucosal dissection (ESD). We conducted the present study to assess the risk of adenoma recurrence requiring endoscopic treatment, and to establish appropriate post-ESD colonoscopic surveillance. We enrolled 116 patients who had undergone colorectal ESD at Okayama University Hospital between February 2008 and July 2014 and had been followed-up &gt; 12 months. We retrospectively analyzed clinicopathological features of 101 lesions from 101 patients. Metachronous adenomas were detected in 21 cases (20.8%). We divided the patients into 2 groups according to the occurrence of metachronous adenomas. Our comparison of clinicopathological characteristics between these groups showed that in the metachronous adenomas group the number of synchronous adenomas at index colonoscopy was high and the rate of laterally spreading tumor-nongranular (LST-NG) was higher. A multivariate analysis indicated that the number of synchronous adenomas was significantly associated with metachronous adenomas (HR: 2.54, 95% CI: 1.04-6.52, p &lt; 0.05). The colonoscopic surveillance planning after colorectal ESD should be more meticulous for patients with more synchronous adenomas.

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  • The Usefulness of Colonoscopy for the Detection of Ileal Involvement in Intestinal Follicular Lymphoma Patients Reviewed

    Masaya Iwamuro, Katsuyoshi Takata, Eiko Hayashi, Seiji Kawano, Sakiko Hiraoka, Yoshiro Kawahara, Tadashi Yoshino, Hiroyuki Okada

    ACTA MEDICA OKAYAMA   71 ( 5 )   391 - 398   2017.10

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    To evaluate the usefulness of colonoscopy for the detection of ileal involvement in patients with intestinal follicular lymphoma, seventeen patients with intestinal follicular lymphoma who underwent colonoscopy and biopsy sampling from the terminal ileum were enrolled. The patients were divided into 2 groups: cases with ileal involvement (n=6) and cases without ileal involvement (n=11). Patients' clinical backgrounds were compared between the two groups. Subsequently, 10 board-certified endoscopists independently evaluated the endoscopic pictures and determined whether the ileum was involved with follicular lymphoma. Infiltration of follicular lymphoma cells were identified in 6 patients (35.3%). Cases with positive ileal involvement were diagnosed with follicular lymphoma at a younger age than were cases without ileal involvement (55.4 +/- 7.4 vs. 68.1 +/- 10.3 years, p=0.011). Macroscopically, in patients with ileal involvement, there were multiple polypoid elevations smaller than 5 mm in 4 cases, single polypoid elevation smaller than 5 mm in 1 case, and single polypoid elevation larger than 5 mm in 1 case. In patients without ileal involvement, there were no lesions in the terminal ileum in 7 cases, and multiple polypoid elevations smaller than 5 mm were seen in 4 cases. The accuracy of the macroscopic evaluation by 10 board-certified endoscopists was 68.8%. Colonoscopy is particularly recommended during the initial workup of patients with follicular lymphoma diagnosed at age &lt;= 60 years. The diagnosis of ileal involvement based on morphology alone is difficult; thus, biopsy and pathologic diagnosis are required for accurate diagnosis.

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  • 当院での潰瘍性大腸炎患者における上部消化管病変の検討

    加藤 諒, 岩室 雅也, 平岡 佐規子, 高嶋 志保, 半井 明日香, 井口 俊博, 岡田 裕之

    Gastroenterological Endoscopy   59 ( Suppl.2 )   2237 - 2237   2017.9

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  • Two electrosurgical endo-knives for endoscopic submucosal dissection of colorectal superficial neoplasms: a prospective randomized study. Reviewed International journal

    Sugihara Y, Harada K, Kawahara Y, Takei D, Takashima S, Inokuchi T, Nakarai A, Takahara M, Kuwaki K, Hiraoka S, Okada H

    Endoscopy international open   5 ( 8 )   E729 - E735   2017.8

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    BACKGROUND AND STUDY AIMS : Few studies have directly compared endo-knives for endoscopic submucosal dissection (ESD) in humans. We compared the performances of the Mucosectom2 and SB knife Jr. PATIENTS AND METHODS:  Two trainee endoscopists performed ESD of 36 lesions in this prospective, randomized controlled trial. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection using the Mucosectom2 were performed in 1 group. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection with a SB knife Jr. were performed in the other group. The primary outcome was the ESD procedure time. Secondary outcomes were total procedure time, self-completion rates, and adverse events. RESULTS : ESD time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (57 ± 32 min vs. 61 ± 44 min, respectively; P  = 0.94). Total procedure time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (81 ± 42 min vs. 82 ± 51 min, respectively; P =  0.85). The trainee self-completion rate was slightly higher in SB knife Jr. patients than in Mucosectom2 patients, although the difference was not significant (94 % vs. 100 %, respectively; P  = 0.959). Fewer hemostatic procedures using the Coagrasper were performed in Mucosectom2 patients than in SB knife Jr. patients, although the difference was not significant (0.62 vs. 0.7, respectively; P  = 0.432). CONCLUSIONS:  Mucosectom2 and SB knife Jr. did not significantly differ in performance for colorectal ESD to safely and reliably enhance ESD. Knife selection is not as important for learning colorectal ESD as patient- and lesion-related factors.

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  • Comparing reduced-dose sodium phosphate tablets to 2 L of polyethylene glycol: A randomized study Reviewed

    Soichiro Ako, Koji Takemoto, Eriko Yasutomi, Chihiro Sakaguchi, Mayu Murakami, Tomoko Sunami, Shohei Oka, Hamada Kenta, Noriko Okazaki, Yuki Baba, Yasushi Yamasaki, Toshiyuki Asato, Daisuke Kawai, Ryuta Takenaka, Hirohumi Tsugeno, Sakiko Hiraoka, Jun Kato, Shigeatsu Fujiki

    WORLD JOURNAL OF GASTROENTEROLOGY   23 ( 24 )   4454 - 4461   2017.6

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    AIM
    To compare the tolerability and quality of bowel cleansing between 2 L polyethylene glycol (PEG) and reduced-dose sodium phosphate (NaP) tablets as a preparation for colonoscopy.
    METHODS
    Two hundred patients were randomly assigned to the PEG or NaP groups at the same ratio. The NaP group patients took 30 tablets with 2 L of clear liquid, while the PEG group patients took 2L of PEG. Tolerability was assessed by a questionnaire about taste, volume, and the overall impression. The bowel cleansing quality was evaluated by colonoscopists.
    RESULTS
    Although NaP showed better tolerability in terms of taste, volume and overall impression (P &lt; 0.01, P &lt; 0.01 and P = 0.02, respectively), the overall cleansing quality was better in the PEG group (P &lt; 0.01). A subgroup analysis, stratified by sex and age, indicated that NaP was associated with better tolerability and equivalent bowel cleansing quality in females of &lt; 50 years of age.
    CONCLUSION
    Despite the better tolerability, the use of 30 NaP tablets with 2 L of clear liquid should be limited due to its lower cleansing quality; however, in certain cases the regimen may deserve consideration, particularly in cases involving young women.

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  • Acute Appendicitis Caused by Previous Endoscopic Submucosal Dissection for an Adenoma Adjacent to the Appendiceal Orifice. Reviewed International journal

    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   2017.5

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    Endoscopic submucosal dissection (ESD) is a groundbreaking treatment for tumors adjacent to the appendiceal orifice that are difficult to remove by conventional endoscopic mucosal resection, and successful cases are increasingly reported. However, little is known about the subsequent complications, especially long-term complications. A female in her early 70s with a 15-mm cecal tumor adjacent to the appendiceal orifice - discovered incidentally during a screening colonoscopy - underwent hybrid ESD of the lesion. We completely resected the tumor, and she was discharged 5 days later with a pathological diagnosis of high-grade tubular adenoma. Ten months postoperatively, she experienced sudden-onset right lower quadrant pain and was diagnosed with acute appendicitis at another hospital. Due to suspicion that her condition was the result of residual tumor, her surgeon performed an emergency laparoscopic cecectomy. The pathological examination of the resected specimen showed thick scarring adjacent to the appendiceal orifice and no residual tumor. The previous ESD was identified as the cause of the scar, and the scar was the only finding to account for the patient's appendicitis. This case is significant because the patient required additional surgery due to a complication of ESD. Further, it indicates that acute appendicitis may be a late complication of submucosal dissection near the appendiceal orifice. As ESD becomes more widely used, it is likely that more cecal tumors will be treated endoscopically. It is important to be aware of the late complications of ESD for these tumors.

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  • Two Cases of Rectal Xanthoma Presenting as Yellowish to Whitish Lesions during Colonoscopy. Reviewed International journal

    Iwamuro M, Tanaka T, Takei D, Sugihara Y, Harada K, Hiraoka S, Kawahara Y, Okada H

    Case reports in gastrointestinal medicine   2017   5975107 - 5975107   2017

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    Two cases of rectal xanthomas are described. One case is that of a 56-year-old Japanese man in whom multiple yellowish spots measuring approximately 3 to 5 mm were observed in the rectum during colonoscopy. The other case is that of a 78-year-old Japanese man in whom colonoscopy showed a whitish plaque of 4 mm in diameter in the rectum. Biopsy examinations performed on both patients revealed the deposition of xanthoma cells within the rectal mucosa. Within the gastrointestinal tract, xanthomas most frequently arise in the stomach, whereas the colorectum is rarely affected. Despite this infrequency, the two cases indicate that xanthomas should be recalled when yellowish to whitish lesions are observed in the colorectum.

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  • A Calcium Enterolith in a Patient with Crohn's Disease and Its In Vitro Dissolubility in Citric Acid. Reviewed

    Iwamuro M, Urata H, Hiraoka S, Ohmori M, Kondo Y, Kawahara Y, Okada H

    Case reports in gastrointestinal medicine   2017   2951547   2017

  • 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

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    <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+CD45RBhighT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>

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  • A Novel Role of Spred2 in the Colonic Epithelial Cell Homeostasis and Inflammation Reviewed

    Sakuma Takahashi, Teizo Yoshimura, Takahiro Ohkura, Masayoshi Fujisawa, Soichiro Fushimi, Toshihiro Ito, Junya Itakura, Sakiko Hiraoka, Hiroyuki Okada, Kazuhide Yamamoto, Akihiro Matsukawa

    SCIENTIFIC REPORTS   6   37531   2016.11

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    Rapid and adequate mucosal healing is important for a remission of ulcerative colitis (UC) patients. Here, we examined whether Spred2, a member of the Sprouty-related EVH1-domain-containing proteins that inhibit the Ras/Raf/ERK pathway, plays a role in colonic mucosal homeostasis and inflammation by using Spred2 knockout (KO) mice. We first detected increased epithelial cell proliferation and cadherin 1 expression in the colon of naive Spred2 KO mice compared to wild-type mice. Interestingly, Spred2 KO mice were resistant to dextran sulfate sodium (DSS)-induced acute colitis as indicated by lower levels of body weight loss and disease activity index. Histologically, epithelial cell injury and inflammation were milder in the colonic mucosa of Spred2 KO mice on day 3 and almost undetectable by day 8. Experiments with bone chimeric mice indicated that Spred2 deficiency in non-hematopoietic cells was responsible for the reduced sensitivity to DSS. Finally, Spred2 KO mice developed significantly fewer tumors in response to azoxymethane plus DSS. Taken together, our results demonstrate, for the first time, that Spred2 plays an important role in the regulation of colonic epithelial cell proliferation and inflammation by potentially down-regulating the activation of ERK. Thus, Spred2 may be a new therapeutic target for the treatment of UC.

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  • Ulcerative colitis patients in clinical remission demonstrate correlations between fecal immunochemical test results, mucosal healing, and risk of relapse Reviewed

    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   2016.6

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    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 &lt;= 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 &gt; 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.

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  • 【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   2016.5

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    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)

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    Other Link: 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

  • Lymphoid hyperplasia of the colon and its association with underlying allergic airway diseases Reviewed

    Masaya Iwamuro, Sakiko Hiraoka, Hiroyuki Okada, Yoshinari Kawai, Yoshio Miyabe, Katsuyoshi Takata, Seiji Kawano, Kazuhide Yamamoto

    INTERNATIONAL JOURNAL OF COLORECTAL DISEASE   31 ( 2 )   313 - 317   2016.2

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    The purpose of this study was to determine the prevalence of lymphoid hyperplasia in the lower gastrointestinal tract and its role in patients undergoing colonoscopic examinations, particularly focusing on any allergic predisposition.
    A database search performed at the Department of Gastroenterology at Onomichi Municipal Hospital identified seven patients with lymphoid hyperplasia in the large intestine (i.e., cecum, colon, and/or rectum). Data regarding the endoscopic, biological, and pathological examinations performed and the allergic histories for each patient were retrospectively reviewed from the clinical records.
    Median age of the patients (four males, three females) was 50 years. Lymphoid hyperplasia was seen in the cecum (n = 5), ascending colon (n = 2), and transverse colon (n = 1). Six patients (85.7 %) had one of the allergic airway diseases: allergic rhinoconjunctivitis for pollen (n = 3), bronchial asthma (n = 1), infantile asthma (n = 1), or allergic bronchitis (n = 1). Drug allergy (n = 3) and urticaria (n = 2) were also found. All seven patients had one or more allergic diseases; however, none had a history of food allergy. Blood tests for allergens revealed that six patients (85.7 %) had positive reactions to inherent allergens, whereas only one patient had a positive reaction to food allergens.
    Our results indicate that lymphoid hyperplasia in the large intestine may be associated with allergic airway diseases rather than with food allergies; thus, its presence may be useful to detect patients with underlying airway hyperreactivity.

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  • Fecal immunochemical test as a biomarker for inflammatory bowel diseases: Can it rival fecal calprotectin? Reviewed

    Jun Kato, Sakiko Hiraoka, Asuka Nakarai, Shiho Takashima, Toshihiro Inokuchi, Masao Ichinose

    Intestinal Research   14 ( 1 )   5 - 14   2016

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    Accurate evaluation of disease activity is essential for choosing an appropriate treatment and follow-up plan for patients with inflammatory bowel disease (IBD). Endoscopy is required for accurately evaluating disease activity, but the procedures are sometimes invasive and burdensome to patients. Therefore, alternative non-invasive methods for evaluating or predicting disease activity including mucosal status are desirable. Fecal calprotectin (Fcal) is the most widely used fecal marker for IBD, and many articles have described the performance of the marker in predicting disease activity, mucosal healing (MH), treatment efficacy, and risk of relapse. Fecal immunochemical test (FIT) can quantify the concentration of hemoglobin in stool and was originally used for the screening of colorectal cancer. We recently reported that FIT is also a useful biomarker for IBD. A direct comparison between the use of Fcal and FIT showed that both methods predicted MH in ulcerative colitis equally well. However, in the case of Crohn's disease, FIT was less sensitive to lesions in the small intestine, compared to Fcal. FIT holds several advantages over Fcal in regards to user-friendliness, including a lower cost, easy and clean handling, and the ability to make rapid measurements by using an automated measurement system. However, there is insufficient data to support the application of FIT in IBD. Further studies into the use of FIT for evaluating the inflammatory status of IBD are warranted.

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  • Clinical Features of Intestinal Behcet's Disease Associated with Myelodysplastic Syndrome and Trisomy 8 Reviewed

    Seiji Kawano, Sakiko Hiraoka, Hiroyuki Okada, Mitsuhiro Akita, Masaya Iwamuro, Kazuhide Yamamoto

    ACTA MEDICA OKAYAMA   69 ( 6 )   365 - 369   2015.12

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    Several studies have identified a relationship between myelodysplastic syndrome and Beket's disease (BD), especially intestinal BD, and trisomy 8 appears to play an important role in these disorders. Despite this, only few case reports or series have been reported in gastroenterology, meaning that endoscopic findings and characteristics of intestinal 131) have not been clarified yet. In this report, we describe three cases of intestinal BD associated with myelodysplastic syndrome and trisomy 8, and discuss the clinical features and problems of these disorders from a gastroenterology perspective.

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  • An open-label prospective randomized multicenter study of intensive versus weekly granulocyte and monocyte apheresis in active crohn's disease Reviewed

    Naoki Yoshimura, Yoko Yokoyama, Katsuyoshi Matsuoka, Hiroki Takahashi, Ryuichi Iwakiri, Takayuki Yamamoto, Tomoo Nakagawa, Takumi Fukuchi, Satoshi Motoya, Reiko Kunisaki, Shingo Kato, Fumihito Hirai, Yoh Ishiguro, Satoshi Tanida, Sakiko Hiraoka, Keiichi Mitsuyama, Shunji Ishihara, Shinji Tanaka, Michiro Otaka, Taro Osada, Takashi Kagaya, Yasuo Suzuki, Hiroshi Nakase, Hiroyuki Hanai, Kenji Watanabe, Nobuhito Kashiwagi, Toshifumi Hibi

    BMC GASTROENTEROLOGY   15   163   2015.11

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    Background: Granulocyte and monocyte adsorptive apheresis (GMA) has shown efficacy in patients with active Crohn's disease (CD). However, with routine weekly therapy, it may take several weeks to achieve remission. This study was performed to assess clinical efficacy and safety of intensive GMA in patients with active CD.
    Methods: In an open-label, prospective, randomized multicentre setting, 104 patients with CD activity index (CDAI) of 200 to 450 received intensive GMA, at two sessions per week (n = 55) or one session per week (n = 49). Clinical remission was defined as a CDAI score &lt;150. Patients in each arm could receive up to 10 GMA sessions. However, GMA treatment could be discontinued when CDAI decreased to &lt;150 (clinical remission level).
    Results: Of the 104 patients, 99 were available for efficacy evaluation as per protocol, 45 in the weekly GMA group, and 54 in the intensive GMA group. Remission was achieved in 16 of 45 patients (35.6 %) in the weekly GMA and in 19 of 54 (35.2 %) in the intensive GMA (NS). Further, the mean time to remission was 35.4 +/- 5.3 days in the weekly GMA and 21.7 +/- 2.7 days in the intensive GMA (P = 0.0373). Elevated leucocytes and erythrocyte sedimentation rate were significantly improved by intensive GMA, from 8005/mu L to 6950/mu L (P = 0.0461) and from 54.5 mm/hr to 30.0 mm/hr (P = 0.0059), respectively. In both arms, GMA was well tolerated and was without safety concern.
    Conclusions: In this study, with respect to remission rate, intensive GMA was not superior to weekly GMA, but the time to remission was significantly shorter in the former without increasing the incidence of side effects. UMIN registration # 000003666.

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  • [A case of asymptomatic Sjögren's syndrome who developed interstitial pneumonia during monoclonal antibody therapy of Crohn's disease]. Reviewed

    Kohno H, Okada H, Hiraoka S, Tanaka T

    Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology   112 ( 7 )   1326 - 1333   2015.7

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    A 67-year-old woman was diagnosed with ileocolic Crohns disease at 61 years of age. Remission had been induced by the monoclonal antibody adalimumab, and maintenance therapy had continued since her diagnosis. However, she developed respiratory symptoms, including a dry cough. A chest CT scan revealed interstitial shadows in the lower pulmonary lobes. Although no sicca symptoms were noted, she was serologically positive for both anti-Sjögrens syndrome-related antigen A and B antibodies, and salivary gland biopsy showed lymphocytic infiltration. Consequently, she was diagnosed as having asymptomatic Sjögrens syndrome. Infection or drug-induced pulmonary disease was considered unlikely, and the interstitial pneumonia was considered an extra-glandular presentation of Sjögrens syndrome. Thus, interstitial shadows, which appear during immunotherapy for Crohns disease, could indicate asymptomatic Sjögrens syndrome; clinicians should consider this rare clinical picture when assessing such a patient.

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  • Endoscopic radial incision and cutting method for refractory stricture of a rectal anastomosis after surgery Reviewed

    Keita Harada, Seiji Kawano, Sakiko Hiraoka, Yoshiro Kawahara, Yoshitaka Kondo, Hiroyuki Okada

    ENDOSCOPY   47   E552 - E553   2015

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  • An Effective and Safe Sedation Technique Combining Target-Controlled Infusion Pump with Propofol, Intravenous Pentazocine, and Bispectral Index Monitoring for Peroral Double-Balloon Endoscopy Reviewed

    Seiji Kawano, Hiroyuki Okada, Masaya Iwamuro, Yoshiyasu Kouno, Kou Miura, Toshihiro Inokuchi, Hiromitsu Kanzaki, Keisuke Hori, Keita Harada, Sakiko Hiraoka, Yoshiro Kawahara, Kazuhide Yamamoto

    DIGESTION   91 ( 2 )   112 - 116   2015

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    Background/Aims: Because peroral double-balloon endoscopy (DBE) is a time-consuming, painful procedure, sedation with analgesics, and/or anesthetics is generally required. The aim of this prospective study was to investigate the safety and efficacy of our sedation protocol for peroral DBE, which consisted of target-controlled infusion (TCI) anesthesia with propofol, an intravenous bolus of pentazocine, and bispectral index (BIS) monitoring. Methods: A total of 34 consecutive patients who underwent DBE by the oral approach were enrolled. Patients were primarily sedated with a continuous infusion of propofol and adjusted in accordance with the BIS levels. The bolus infusion of pentazocine was performed when the propofol infusion was insufficient. The primary outcome measure of this study was to ensure the safety and efficacy of this sedation technique. The secondary purpose was to identify the characteristics of the patient who required the bolus infusion of pentazocine. Results: Five patients (14.7%) required a reduction in the dose of propofol. However, no patient experienced any serious adverse events. All patients (100%) and 80.6% (25/31) of endoscopists answered that the sedation protocol was 'excellent' or 'enough' for peroral DBE. Eleven patients (32.3%) required a bolus injection of pentazocine. Age &lt; 60 years and a total procedure time of &gt; 70 min were significant risk-factors for pentazocine use. Conclusions: A combination of propofol via TCI pump, bolus injection of pentazocine as needed, and BIS monitoring was a safe and effective procedure for peroral DBE. Reasonable satisfaction indices were obtained from both patients and endoscopists. Pentazocine was required for young patients and in cases with longer procedure times. (c) 2015 S. Karger AG, Basel

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  • Prognosis of ulcerative colitis differs between patients with complete and partial mucosal healing, which can be predicted from the platelet count Reviewed

    Asuka Nakarai, Jun Kato, Sakiko Hiraoka, Toshihiro Inokuchi, Daisuke Takei, Yuki Moritou, Mitsuhiro Akita, Sakuma Takahashi, Keisuke Hori, Keita Harada, Hiroyuki Okada, Kazuhide Yamamoto

    WORLD JOURNAL OF GASTROENTEROLOGY   20 ( 48 )   18367 - 18374   2014.12

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    AIM: To determine the difference in clinical outcome between ulcerative colitis (UC) patients with Mayo endoscopic subscore (MES) 0 and those with MES 1.
    METHODS: UC patients with sustained clinical remission of 6 mo or more at the time of colonoscopy were examined for clinical outcomes and the hazard ratios of clinical relapse according to MES. Parameters, including blood tests, to identify predictive factors for MES 0 and slight endoscopic recurrence in clinically stable patients were assessed. Moreover, a receiver operating characteristic curve was generated, and the area under the curve was calculated to indicate the utility of the parameters for the division between complete and partial mucosal healing. All P values were two-sided and considered significant when less than 0.05.
    RESULTS: A total of 183 patients with clinical remission were examined. Patients with MES 0 (complete mucosal healing: n = 80, 44%) were much less likely to relapse than those with MES 1 (partial mucosal healing: n = 89, 48%) (P &lt; 0.0001, log-rank test), and the hazard ratio of risk of relapse in patients with MES 1 vs MES 0 was 8.17 (95% CI: 4.19-17.96, P &lt; 0.0001). The platelet count (PLT) &lt; 26 x 10(4)/mu L was an independent predictive factor for complete mucosal healing (OR = 4.1, 95% CI: 2.15-7.99). Among patients with MES 0 at the initial colonoscopy, patients of whom colonoscopy findings shifted to MES 1 showed significant increases in PLT compared to those who maintained MES 0 (3.8 x 10(4)/mu L vs -0.6 x 10(4)/mu L, P &lt; 0.0001).
    CONCLUSION: The relapse rate differed greatly between patients with complete and partial mucosal healing. A shift from complete to partial healing in clinically stable UC patients can be predicted by monitoring PLT. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

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  • Long-term follow-up of ulcerative colitis patients treated on the basis of their cytomegalovirus antigen status Reviewed

    Toshihiro Inokuchi, Jun Kato, Sakiko Hiraoka, Hideyuki Suzuki, Asuka Nakarai, Tomoko Hirakawa, Mitsuhiro Akita, Sakuma Takahashi, Keita Harada, Hiroyuki Okada, Kazuhide Yamamoto

    WORLD JOURNAL OF GASTROENTEROLOGY   20 ( 2 )   509 - 517   2014.1

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    AIM: To clarify the impact of cytomegalovirus (CMV) activation and antiviral therapy based on CMV antigen status on the long-term clinical course of ulcerative colitis (UC) patients.
    METHODS: UC patients with flare-up were divided into CMV-positive and -negative groups according to the CMV antigenemia assay. The main treatment strategy provided for the patients in the CMV-positive group comprised a dose reduction of corticosteroids and administration of ganciclovir.
    RESULTS: The median number of days to initial remission was significantly greater for the patients in the CMV-positive group (21 d vs 16 d, P = 0.009). However, the relapse rate after remission and colectomy rate during more than 30 mo of observation did not differ between the two groups. Multivariate analysis revealed that administration of ganciclovir was the only independent factor for avoiding colectomy in patients of the CMV-positive group.
    CONCLUSION: CMV antigen status did not significantly affect the long-term prognosis in UC patients under treatment with appropriate antiviral therapy. (C) 2014 Baishideng Publishing Group Co., Limited. All rights reserved.

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  • 【大腸側方発育型腫瘍(LST)-新たな時代へ】LSTの遺伝子学的特徴 大腸癌の発癌機序からみたLSTの位置づけ

    平岡 佐規子, 原田 馨太, 加藤 順

    Intestine   18 ( 1 )   53 - 60   2014.1

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    側方に発育する大腸腫瘍であるLST-G,LST-NG,sessile serrated adenoma/polyp(SSA/P)は,分子生物学的にも違いがあり,それぞれ異なった発癌過程を反映する形態変化と考えられる.形態により違いのみられるおもな遺伝子変化は,RAS/RAF/MAPK系シグナルの遺伝子変異(K-ras,BRAF変異)とDNAメチル化の頻度(CIMP)であり,LST-GはK-ras変異,CIMP-low,LST-NGはCIMP-negative,SSA/PはBRAF変異,CIMP-highがそれぞれ特徴的である.(著者抄録)

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  • Slight Increases in the Disease Activity Index and Platelet Count Imply the Presence of Active Intestinal Lesions in C-reactive Protein-negative Crohn's Disease Patients Reviewed

    Asuka Nakarai, Jun Kato, Sakiko Hiraoka, Toshihiro Inokuchi, Daisuke Takei, Yuki Morito, Mitsuhiro Akita, Sakuma Takahashi, Keisuke Hori, Keita Harada, Hiroyuki Okada, Kazuhide Yamamoto

    INTERNAL MEDICINE   53 ( 17 )   1905 - 1911   2014

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    Objective Although the serum C-reactive protein (CRP) level may, to some extent, predict the disease activity in patients with Crohn's disease (CD), it is not always elevated during periods of disease activity. This study aimed to identify factors predicting the presence of active intestinal lesions in CD patients without an elevated CRP level.
    Methods CD patients in whom the presence or absence of active intestinal lesions was evaluated using endoscopic and/or radiologic modalities were divided into two groups based on a negative (&lt; 3 mg/L) or positive (&gt;= 3 mg/L) CRP level. The correlations between the presence of active intestinal lesions and various clinical variables, including the Crohn's Disease Activity Index (CDAI), leukocyte and platelet counts and hemoglobin, serum albumin and CRP levels, were determined in the CRP-negative patients.
    Results Of the 128 patients examined, 70 had a negative CRP status, approximately half of whom had active intestinal lesions. The multivariate analysis revealed a CDAI of &gt; 100 and platelet count of &gt; 33x10(4)/mu L to be significant predictive factors for the presence of active lesions in the CRP-negative patients [CDAI &gt; 100, odds ratio (OR) = 5.55; 95% confidence interval (CI), 1.80-18.74, platelet count &gt; 33x10(4)/mu L, OR = 5.94; 95% CI, 1.34-28.87]. The sensitivity of fulfillment of either criterion for the presence of active intestinal lesions was 83%, while the specificity of fulfillment of both criteria was 94%.
    Conclusion A relatively low CDAI and platelet count were identified as predictive markers of the presence of active intestinal lesions in CRP-negative CD patients. These results suggest that symptoms and laboratory data should be evaluated very carefully in such patients.

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  • Serum Glycan Markers for Evaluation of Disease Activity and Prediction of Clinical Course in Patients with Ulcerative Colitis Reviewed

    Koji Miyahara, Kazuhiro Nouso, Shunsuke Saito, Sakiko Hiraoka, Keita Harada, Sakuma Takahashi, Yuki Morimoto, Sayo Kobayashi, Fusao Ikeda, Yasuhiro Miyake, Hidenori Shiraha, Akinobu Takaki, Hiroyuki Okada, Maho Amano, Kazuko Hirose, Shin-Ichiro Nishimura, Kazuhide Yamamoto

    PLoS ONE   8 ( 10 )   e74861   2013.10

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    Background:The aims of this study were to determine the change of whole-serum N-glycan profile in ulcerative colitis (UC) patients and to investigate its clinical utility.Methods:We collected serum from 75 UC patients at the time of admission and the same number of age/sex-matched healthy volunteers. Serum glycan profile was measured by comprehensive quantitative high-throughput glycome analysis and was compared with disease activity and prognosis.Results:Out of 61 glycans detected, 24 were differentially expressed in UC patients. Pathway analysis demonstrated that highly sialylated multi-branched glycans and agalactosyl bi-antennary glycans were elevated in UC patients
    in addition, the glycan ratio m/z 2378/1914, which also increased in UC, showed the highest Area under Receiver Operating Characteristic curve (0.923) for the diagnosis of UC. Highly sialylated multi-branched glycans and the glycan ratio m/z 2378/1914 were higher in the patients with total colitis, Clinical Activity Index &gt
    10, Mayo endoscopic score 3, or a steroid-refractory status. In particular, the glycan ratio m/z 2378/1914 (above median) was an independent prognostic factor for the need for an operation (hazard ratio, 2.67
    95% confidence interval, 1.04-7.84).Conclusions:Whole-serum glycan profiles revealed that the glycan ratio m/z 2378/1914 and highly sialylated multi-branched glycans increase in UC patients, and are correlated with disease activity. The glycan ratio m/z 2378/1914 was an independent predictive factor of the prognosis of UC. © 2013 Miyahara et al.

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  • 潰瘍性大腸炎の活動性・予後予測における血清糖鎖マーカーの有用性

    宮原 孝治, 能祖 一裕, 平岡 佐規子, 森元 裕貴, 高橋 索真, 小林 沙代, 斎藤 俊介, 原田 馨太, 山本 和秀, 天野 麻穂, 西村 紳一郎

    日本臨床分子医学会学術総会プログラム・抄録集   50回   76 - 76   2013.4

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  • Noninvasive evaluation of mucosal healing in inflammatory bowel diseases Reviewed

    Jun Kato, Sakiko Hiraoka, Asuka Nakarai, Masao Ichinose

    Clinical Journal of Gastroenterology   6 ( 1 )   1 - 7   2013.2

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    Current opinions increasingly cite the need to achieve not only clinical response but also endoscopic mucosal healing in the treatment of both types of inflammatory bowel disease: ulcerative colitis (UC) and Crohn's disease (CD). Although endoscopic procedures are necessary for confirmation of mucosal healing, undergoing colonoscopy is invasive and burdensome to patients. Therefore, alternative noninvasive methods of evaluating or predicting mucosal status have been eagerly desired. For this purpose, blood, fecal, and radiologic modalities have been suggested and examined. C-reactive protein and fecal markers such as fecal calprotectin can evaluate active inflammation to some extent in both UC and CD. However, their predictive values for mucosal healing have not yet been fully evaluated and current knowledge indicates that the values were rather insufficient. Radiologic modalities such as computed tomography, magnetic resonance, and ultrasound can also evaluate mucosal inflammation but are currently not suitable for detection of healing. Capsule endoscopy may be optimal for evaluating mucosal status of the small bowel in CD patients, but sufficient data are not yet available, particularly for mucosal healing. Thus, these candidates for the surrogate modality are currently imperfect for evaluation of mucosal healing, but the changes in values/findings of these modalities after initiation of therapy appear to be rather promising as a marker of efficacy of the therapy. Finally, our recent data showed that a fecal immunochemical test for evaluation of mucosal healing in UC was very promising and this method should be further evaluated in CD also. © 2012 Springer Japan.

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  • Is presence or history of extracolonic primary malignancy a risk for colorectal Neoplasia? An analysis of patients who underwent colonoscopy Reviewed

    Mitsuhiro Akita, Sakiko Hiraoka, Eisuke Kajia, Koji Takemoto, Yasuhiro Nagahara, Hiroshi Yamamot, Kazuhide Yamamoto, Jun Kato

    Acta Medica Okayama   67 ( 5 )   285 - 292   2013

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    Whether presence or history of extracolonic primary malignancy is a risk for colorectal neoplasia is not fully known. In this study, 26,452 first-time colonoscopy cases were examined using a colonoscopy database. Among the analyzed subjects, 3,026 (11%) subjects had history or concomitance of extracolonic primary malignancy, while the remaining 23,426 subjects did not. Colorectal neoplasia was observed in 39% of all the subjects. A crude comparison showed that the prevalence of any type of colorectal neoplasia was higher in subjects with extracolonic malignancy than in those without (42% vs. 39%, p = 0.0012). However, after adjusting for confounding factors, the odds ratios (ORs) of subjects with extracolonic malignancy for having colorectal neoplasia, advanced neoplasia, and cancer were all less than 1.0, and all significantly different from those of subjects without extracolonic malignancy. Analysis according to the type of extracolonic malignancy revealed that gastric cancer cases had a significantly lower risk for colorectal advanced neoplasia (OR: 0.81
    95% CI: 0.67-0.99). Among major malignancies, only esophageal squamous cell cancer cases had increased risk for colorectal neoplasia (OR: 1.66
    95% CI: 1.20-2.29). Patients with presence or history of extracolonic malignancy did not carry a higher risk of occurrence of colorectal neoplasia. © 2013 by Okayama University Medical School.

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  • Externalization of Saw-Tooth Architecture in Small Serrated Polyps Implies the Presence of Methylation of IGFBP7 Reviewed

    Eisuke Kaji, Toshio Uraoka, Jun Kato, Sakiko Hiraoka, Hideyuki Suzuki, Mitsuhiro Akita, Shunsuke Saito, Takehiro Tanaka, Nobuya Ohara, Kazuhide Yamamoto

    DIGESTIVE DISEASES AND SCIENCES   57 ( 5 )   1261 - 1270   2012.5

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    Serrated polyps have been considered to be precursors of colorectal cancer with microsatellite instability. However, the biological and/or morphological changes which occur during the course of serrated polyp to cancer remain to be elucidated.
    Twenty-eight colorectal serrated polyps including five mixed polyps (MP) from 20 patients were observed by chromoendoscopy with magnification, and subsequently resected endoscopically. The presence of mutations in two genes (K-ras and BRAF) and the methylation status of six genes (MLH1-A, MLH1-C, ESR1, P16, SOCS1, and IGFBP7) were examined.
    The 28 polyps included 32 histological serrated lesions (22 sessile serrated adenomas [SSA], six hyperplastic polyps [HP], and four traditional serrated adenoma [TSA]-like lesions). BRAF mutation was frequently observed in SSAs (19/22), while K-ras mutation was dominant in HPs (5/6). The externalization of saw-tooth architecture in serrated polyps was endoscopically observed more frequently in those with high levels of IGFBP7 methylation (P = 0.03). Moreover, the endoscopic finding was observed in five of six small serrated lesions (&lt; 10 mm) which contained both BRAF mutation and high levels of IGFBP7 methylation. TSA-like lesions in small MPs demonstrated the endoscopic finding with no or little MLH1 methylation, while the counterparts in the mixed polyps had high levels of MLH1 methylation with relatively low levels of IGFBP7 methylation.
    Our data suggests two distinct pathways may be involved in the early stages of the serrated pathway: one where MLH1 is primarily methylated, and a second where methylated IGFBP7 is associated with an externalization of saw-tooth architecture.

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  • Development of Invasive Colon Cancer with Microsatellite Instability in a Patient with Hyperplastic Polyposis Syndrome Reviewed

    Joichiro Horii, Jun Kato, Takeshi Nagasaka, Sakiko Hiraoka, Dong-Sheng Sun, Kazuo Watanabe, Isao Fujita, Tatsuya Toyokawa, Jun Tomoda, Kazuhide Yamamoto

    JAPANESE JOURNAL OF CLINICAL ONCOLOGY   42 ( 5 )   451 - 454   2012.5

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    The serrated pathway has recently been proposed as a route for the development of colorectal cancer with microsatellite instability. Hyperplastic polyposis syndrome is a rare syndrome defined by the presence of numerous serrated polyps, with a high risk of developing into colorectal cancer. We present here a case of hyperplastic polyposis syndrome developing into colorectal cancer with microsatellite instability from a serrated polyp. BRAF mutation and the loss of MLH1 protein were observed in the colorectal cancer, but not in the other serrated polyps around the colorectal cancer, suggesting that colorectal cancer with microsatellite instability develops rapidly from a specific serrated polyp with distinct molecular properties.

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  • Detectability of colorectal neoplasia with fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography (FDG-PET/CT) Reviewed

    Tomoko Hirakawa, Jun Kato, Yoshihiro Okumura, Keisuke Hori, Sakuma Takahashi, Hideyuki Suzuki, Mitsuhiro Akita, Reiji Higashi, Shunsuke Saito, Eisuke Kaji, Toshio Uraoka, Sakiko Hiraoka, Kazuhide Yamamoto

    JOURNAL OF GASTROENTEROLOGY   47 ( 2 )   127 - 135   2012.2

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    The purpose of this study was to analyze the detectability of colorectal neoplasia with fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT).
    Data for a total of 492 patients who had undergone both PET/CT and colonoscopy were analyzed. After the findings of PET/CT and colonoscopy were determined independently, the results were compared in each of the six colonic sites examined in all patients. The efficacy of PET/CT was determined using colonoscopic examination as the gold standard.
    In all, 270 colorectal lesions 5 mm or more in size, including 70 pathologically confirmed malignant lesions, were found in 172 patients by colonoscopy. The sensitivity and specificity of PET/CT for detecting any of the colorectal lesions were 36 and 98%, respectively. For detecting lesions 11 mm or larger, the sensitivity was increased to 85%, with the specificity remaining consistent (97%). Moreover, the sensitivity for tumors 21 mm or larger was 96% (48/50). Tumors with malignant or high-grade pathology were likely to be positive with PET/CT. A size of 10 mm or smaller [odds ratio (OR) 44.14, 95% confidence interval (95% CI) 11.44-221.67] and flat morphology (OR 7.78, 95% CI 1.79-36.25) were significant factors that were associated with false-negative cases on PET/CT.
    The sensitivity of PET/CT for detecting colorectal lesions is acceptable, showing size- and pathology-dependence, suggesting, for the most part, that clinically relevant lesions are detectable with PET/CT. However, when considering PET/CT for screening purposes caution must be exercised because there are cases of false-negative results.

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  • DNA Methylation of Colon Mucosa in Ulcerative Colitis Patients: Correlation with Inflammatory Status Reviewed

    Shunsuke Saito, Jun Kato, Sakiko Hiraoka, Joichiro Horii, Hideyuki Suzuki, Reiji Higashi, Eisuke Kaji, Yoshitaka Kondo, Kazuhide Yamamoto

    INFLAMMATORY BOWEL DISEASES   17 ( 9 )   1955 - 1965   2011.9

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    Background: Although DNA methylation of colonic mucosa in ulcerative colitis (UC) has been suggested, the majority of published reports indicate the correlation between methylation of colon mucosa and occurrence of UC-related dysplasia or cancer without considering the mucosal inflammatory status. The aim of this study was to verify whether mucosal inflammation-specific DNA methylation occurs in the colon of UC.
    Methods: Of 15 gene loci initially screened, six loci (ABCB1, CDH1. ESR1, GDNF, HPP1, and MYOD1) methylated in colon mucosa of UC were analyzed according to inflammatory status using samples from 28 surgically resected UC patients.
    Results: Four of six regions (CDH1, GDNF, HPP1, and MYOD1) were more highly methylated in the active inflamed mucosa than in the quiescent mucosa in each UC patient (P = 0.003, 0.0002, 0.02, and 0.048, respectively). In addition, when the methylation status of all samples taken from examined patients was stratified according to inflammatory status, methylation of CDHI and GDNF loci was significantly higher in active inflamed mucosa than in quiescent mucosa (P = 0.045 and 0.002, respectively). Multiple linear regression analysis revealed that active inflammation was an independent factor of methylation for CDHI and GDNF. DNA methyltransferase 1 and 3b were highly expressed in colon epithelial cells with active mucosa] inflammation, suggesting their involvement in inflammation-dependent methylation.
    Conclusions: Methylation in colonic mucosa of UC was correlated with mucosal inflammatory status, suggesting the involvement of methylation due to chronic active inflammation in UC carcinogenesis.

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  • Is sigmoidoscopy sufficient for evaluating inflammatory status of ulcerative colitis patients? Reviewed

    Jun Kato, Motoaki Kuriyama, Sakiko Hiraoka, Kazuhide Yamamoto

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   26 ( 4 )   683 - 687   2011.4

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    Background and Aims:
    An adequate range of colonic observations for precise evaluation of inflammation in ulcerative colitis (UC) patients has not been reported.
    Methods:
    Retrospective analysis of 545 colonoscopic examinations of UC patients was carried out. Severity of mucosal inflammation was evaluated using the Mayo score of endoscopic index at each location (rectum, sigmoid colon, descending colon, and the oral side of the splenic flexure) in each patient. The colonic site with maximum inflammation was determined for each patient.
    Results:
    Of 545 patients, 319 (59%) had maximum inflammation in the rectum, 79 (14%) in the sigmoid colon, 70 (13%) in the descending colon, and 77 (14%) on the oral side of the splenic flexure. Severe inflammatory activity (Mayo 3) was observed more frequently in patients who had maximum activity in the descending colon or the more proximal portion than those who had this in the rectum or sigmoid colon (42% vs 25%, P &lt; 0.0001). The first-attack patients were significantly more frequently found in patients with maximum severity in the descending colon or the oral side of splenic flexure than those with maximum severity in the rectum or sigmoid colon (P = 0.016). Moreover, among 134 patients with no inflammation in the rectum and sigmoid colon, 54 (40%) had inflamed mucosa in the descending colon or the more proximal portion.
    Conclusions:
    Sigmoidoscopy is not sufficient for evaluating inflammation in UC patients. In particular, colonoscopy is necessary for first-attack patients and patients who have a discrepancy between rectosigmoid observation and symptoms.

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  • Analysis of K-ras, BRAF, and PIK3CA mutations in laterally-spreading tumors of the colorectum Reviewed

    Eisuke Kaji, Jun Kato, Hideyuki Suzuki, Mitsuhiro Akita, Joichiro Horii, Shunsuke Saito, Reiji Higashi, Shin Ishikawa, Motoaki Kuriyama, Sakiko Hiraoka, Toshio Uraoka, Kazuhide Yamamoto

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   26 ( 3 )   599 - 607   2011.3

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    Background and Aims: Laterally-spreading tumors (LST) are a newly-recognized category of colorectal neoplasia, and are defined as lesions larger than 10 mm in diameter and extending circumferentially rather than vertically. However, genetic features of this new category of tumors are not fully elucidated. The aim of this study was to evaluate genetic alterations in LST.
    Methods: We examined K-ras, BRAF, and phosphoinositide-3-kinase catalytic-alpha polypeptide (PIK3CA) mutations in 101 LST, including 68 LST-granular type (LST-G) and 33 LST-non-granular type by direct sequencing. As controls, we examined these gene mutations in 66 protruded colon adenomas (10 mm or larger) and 44 advanced colon cancers.
    Results: K-ras, BRAF, and PIK3CA mutations were observed in 59 (58%), zero (0%), and three (3%) LST, respectively. LST-G morphology in the right-sided colon was significantly correlated with the existence of K-ras mutations, whereas a size of 20 mm or larger was the only predictor of mutations in the left-sided colorectum. The frequency of K-ras mutations in LST was particularly marked in the left-sided colorectum compared to protruded adenomas or advanced cancers (LST vs protruded adenomas, P &lt; 0.001; LST vs advanced cancers, P = 0.002), whereas in the right-sided colon, K-ras mutations were equally frequent. PIK3CA mutations were not familiar in either LST (3%) or advanced cancers (9%).
    Conclusions: K-ras mutations were involved in colorectal LST in different manners according to tumor location.

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  • Serum Folate and Homocysteine Levels Are Associated With Colon Tumorigenesis in End-Stage Renal Disease Patients Reviewed

    Eisuke Kaji, Jun Kato, Shunsuke Saito, Keita Harada, Kenji Kuwaki, Masashi Tatsukawa, Tamiya Morikawa, Sakiko Hiraoka, Hiroshi Matsushima, Kazuhide Yamamoto

    NUTRITION AND CANCER-AN INTERNATIONAL JOURNAL   63 ( 2 )   202 - 211   2011

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    The aim of this study was to evaluate the effect of folate and homocysteine on colon tumorigenesis by performing colonoscopy and examining serum folate and homocysteine levels in end-stage renal disease (ESRD) patients. We performed colonoscopy in 72 ESRD patients who were undergoing hemodialysis and also measured their serum folate and homocysteine levels. Serum folate and homocysteine concentrations of the 72 ESRD patients were 6.0 +/- 3.9 g/l and 37.3 +/- 25.5 mol/l, respectively. Colorectal neoplasia was detected in 47 (65%) of the patients. Compared to a control group, ESRD patients had significantly more and larger neoplasia (P = 0.002 and 0.001, respectively). Multivariate analysis revealed that ESRD patients with lower levels of serum homocysteine had significantly more and larger neoplasia than those with higher levels (P = 0.02 and 0.03, respectively). In addition, patients with a shorter duration of hemodialysis were likely to have larger neoplasia. ESRD patients had higher than normal serum homocysteine levels. Interestingly, patients with lower homocysteine levels were likely to carry more and larger colorectal neoplasia. These results suggest that suppression of folate metabolism and an elevated serum homocysteine concentration are inversely associated with colon tumorigenesis in ESRD patients.

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  • TOLERABILITY AND USEFULNESS OF MERCAPTOPURINE IN AZATHIOPRINE-INTOLERANT JAPANESE PATIENTS WITH ULCERATIVE COLITIS Reviewed

    Motoaki Kuriyama, Jun Kato, Hideyuki Suzuki, Mitsuhiro Akita, Sakiko Hiraoka, Hiroyuki Okada, Kazuhide Yamamoto

    DIGESTIVE ENDOSCOPY   22 ( 4 )   289 - 296   2010.10

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    Background and Aim:
    Azathioprine (AZA) and mercaptopurine (6-MP) are established as effective therapeutic drugs for the induction and maintenance of remission in patients with ulcerative colitis (UC). However, AZA is often intolerable due to adverse effects. Evidence regarding the approach of switching from AZA to 6-MP in patients of Asian ethnicity is lacking. We assessed the tolerability and usefulness of 6-MP in Japanese UC patients who had shown intolerance to AZA.
    Methods:
    One-hundred and ten UC patients who had been treated with AZA and/or 6-MP from January 1985 to October 2008 were examined retrospectively.
    Results:
    Among 110 patients, 107 were treated first with AZA; only three were treated first with 6-MP. Thirty-five (33%) of the 107 patients were intolerant of AZA, with adverse effects including myelosuppression (8/35, 23%), hepatotoxicity (8/35, 23%), and abdominal symptoms (6/35, 17%). Among 35 AZA-intolerant patients, 23 were switched to 6-MP treatment. The cumulative probability of colectomy was significantly higher in patients not treated with 6-MP than in patients treated with 6-MP (log-rank test, P = 0.0002). Among the 26 patients (23 AZA-intolerant and three AZA-untreated) treated with 6-MP, 22 (85%) could tolerate the therapy. Adverse effects due to 6-MP were abdominal symptoms (2/4), myelosuppression (1/4), and rash (1/4). The median initial dose of 6-MP was 20 mg/day, and the median final dose was 30 mg/day.
    Conclusions:
    6-MP was tolerated in 83% of AZA-intolerant patients, and it was effective for maintenance therapy of UC patients. 6-MP treatment should be considered in AZA-intolerant patients.

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  • Prediction of flare-ups of ulcerative colitis using quantitative immunochemical fecal occult blood test Reviewed

    Motoaki Kuriyama, Jun Kato, Koji Takemoto, Sakiko Hiraoka, Hiroyuki Okada, Kazuhide Yamamoto

    WORLD JOURNAL OF GASTROENTEROLOGY   16 ( 9 )   1110 - 1114   2010.3

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    AIM: To examine the feasibility of predicting the flare-up of ulcerative colitis (UC) before symptoms emerge using the immunochemical fecal occult blood test (I-FOBT).
    METHODS: We prospectively measured fecal hemoglobin concentrations in 78 UC patients using the I-FOBT every 1 or 2 mo.
    RESULTS: During a 20 mo-period, 823 fecal samples from 78 patients were submitted. The median concentration of fecal hemoglobin was 41 ng/mL (range: 0-392500 ng/mL). There were three types of patients with regard to the correlation between I-FOBT and patient symptoms; the synchronous transition type with symptoms (44 patients), the unrelated type with symptoms (19 patients), and the flare-up predictive type (15 patients). In patients with the flare-up predictive type, the values of I-FOBT were generally low during the study period with stable symptoms. Two to four weeks before the flare-up of symptoms, the I-FOBT values were high. Thus, in these patients, I-FOBT could predict the flare-up before symptoms emerged.
    CONCLUSION: Flare-up could be predicted by I-FOBT in approximately 20% of UC patients. These results warrant periodical I-FOBT in UC patients. (C) 2010 Baishideng. All rights reserved.

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  • Specific endoscopic features of ulcerative colitis complicated by cytomegalovirus infection Reviewed

    Hideyuki Suzuki, Jun Kato, Motoaki Kuriyama, Sakiko Hiraoka, Kenji Kuwaki, Kazuhide Yamamoto

    WORLD JOURNAL OF GASTROENTEROLOGY   16 ( 10 )   1245 - 1251   2010.3

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    AIM: To identify specific colonoscopic findings in patients with ulcerative colitis (UC) complicated by cytomegalovirus (CMV) infection.
    METHODS: Among UC patients who were hospitalized due to exacerbation of symptoms, colonoscopic findings were compared between 15 CMV-positive patients and 58 CMV-negative patients. CMV infection was determined by blood test for CMV antigenemia. Five aspects of mucosal changes were analyzed (loss of vascular pattern, erythema, mucosal edema, easy bleeding, and mucinous exudates) as well as five aspects of ulcerative change (wide mucosal defect, punched-out ulceration, longitudinal ulceration, irregular ulceration, and cobblestone-like appearance). Sensitivity, specificity, positive predictive value, and negative predictive value of each finding for CMV positivity were determined.
    RESULTS: The sensitivity of irregular ulceration for positive CMV was 100%. The specificity of wide mucosal defect was 95%. Punched-out ulceration and longitudinal ulceration exhibited relatively high sensitivity and specificity (more than 70% for each).
    CONCLUSION: Specific colonoscopic findings in patients with UC complicated by CMV infection were identified. These findings may facilitate the early diagnosis of CMV infection in UC patients. (C) 2010 Baishideng. All rights reserved.

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  • Methylation status of normal background mucosa is correlated with occurrence and development of neoplasia in the distal colon Reviewed

    Sakiko Hiraoka, Jun Kato, Joichiro Horii, Shunsuke Saito, Keita Harada, Hideyuki Fujita, Motoaki Kuriyama, Koji Takemoto, Toshio Uraoka, Kazuhide Yamamoto

    HUMAN PATHOLOGY   41 ( 1 )   38 - 47   2010.1

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    The aim of this study is to evaluate the methylation status of normal colonic mucosa in relation to the stage of neoplasia arising from the mucosa. The methylation status of 2 age-related loci (ESR1 and MYOD1) and global methylation (the mean of Alu and Sat2) in the normal colonic mucosa of 156 patients with and without colorectal neoplasia were examined. The distal colon and proximal colon were analyzed separately because neoplasia is biologically and clinically different between these sites. The methylation status was determined by MethyLight using percentage of methylated reference (PMR). In the distal colon, methylation of the age-related loci decreased as the stage of neoplasia increased (patients with no neoplasia or with adenoma &lt;= 9 mm versus patients with advanced adenoma or with invasive cancer: ESR1-PMR median, 21.0 versus 15.7; P = .015; MYOD1-PMR median, 5.35 versus 3.80; P = .0037, respectively). Interestingly, global methylation was inversely correlated with the stage of neoplasia (59.7 versus 61.5; P = .054). In contrast, the proximal colon showed no significant correlations. The methylation of MYOD1 in the normal mucosa was significantly correlated with K-ras mutation in neoplastic tissue arising from the mucosa. Specific epigenetic changes in normal colonic mucosa may be correlated with the occurrence and development of neoplasia in the distal colon. (c) 2010 Elsevier Inc. All rights reserved.

    DOI: 10.1016/j.humpath.2009.06.002

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  • CO2 insufflation for potentially difficult colonoscopies: Efficacy when used by less experienced colonoscopists Reviewed

    Toshio Uraoka, Jun Kato, Motoaki Kuriyama, Keisuke Hori, Shin Ishikawa, Keita Harada, Koji Takemoto, Sakiko Hiraoka, Hicleyuki Fujita, Joichiro Horii, Yutaka Saito, Kazuhicle Yamamoto

    WORLD JOURNAL OF GASTROENTEROLOGY   15 ( 41 )   5186 - 5192   2009.11

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    AIM: To clarify the effectiveness Of CO2 insufflation in potentially difficult colonoscopy cases, particularly in relation to the experience level of colonoscopists.
    METHODS: One hundred twenty potentially difficult cases were included in this study, which involved females with a low body mass index and patients with earlier abdominal and/or pelvic open surgery or previously diagnosed left-side colon diverticulosis. Patients receiving colonoscopy examinations without sedation using a pediatric variable-stiffness colonoscope were divided into two groups based on either CO2 or standard air insufflation. Both insufflation procedures were also evaluated according to the experience level of the respective colonoscopists who were divided into an experienced colonoscopist (EC) group and a less experienced colonoscopist (LEC) group. Study measurements included a 100-mm visual analogue scale (VAS) for patient pain during and after colonoscopy examinations, in addition to insertion to the cecum and withdrawal times.
    RESULTS: Examination times did not differ, however, VAS scores in the CO2 group were significantly better than in the air group (P &lt; 0.001, two-way ANOVA) from immediately after the procedure and up to 2 h later. There were no significant differences between either insufflation method in the EC group (P = 0.29), however, VAS scores for CO2 insufflation were significantly better than air insufflation in the LEC group (P = 0.023) immediately after colonoscopies and up to 4 h afterwards.
    CONCLUSION: CO2 insufflation reduced patient pain after colonoscopy in potentially difficult cases when performed by LECs. (C) 2009 The WJG Press and Baishideng. All rights reserved.

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  • Methylation of estrogen receptor 1 in colorectal adenomas is not age-dependent, but is correlated with K-ras mutation Reviewed

    Joichiro Horii, Sakiko Hiraoka, Jun Kato, Shunsuke Saito, Keita Harada, Hideyuki Fujita, Eisuke Kaji, Kazuhide Yamamoto

    CANCER SCIENCE   100 ( 6 )   1005 - 1011   2009.6

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    The promoter region of estrogen receptor 1 (ESR1) has been shown to be methylated in normal colorectal mucosa in an age-dependent manner. However, the methylation of this region in colorectal tumors has not sufficiently been investigated. The methylation status of ESR1 in 105 colorectal adenoma tissues was examined by MethyLight and presented as the percentage of methylated references (PMR). Factors that affect the PMR of ESR1 in adenomas were determined using parameters including patient age, sex, past history of malignancy, family history of colorectal cancer, smoking and drinking habits, clinical characteristics of adenomas (location, size, macroscopic appearance, and histology), and K-ras mutation. Multiple linear regression revealed that the PMR was not correlated with patient age. K-ras mutation was significantly correlated with the higher methylation status of ESR1 in adenoma (t-value = 3.21, P = 0.0018), whereas alcohol exposure was significantly correlated with lower methylation status (t-value = -2.37, P = 0.02). Because methylation of O(6)-methylguanine DNA methyltransferase (MGMT) has been reported to be correlated with K-ras G-to-A transition, methylation of ESR1 was compared with that of MGMT with regard to K-ras mutation. Contrary to expectations, methylation of MGMT was not significantly correlated with K-ras G-to-A transition, but that of ESR1 was strongly correlated with K-ras G-to-A transition. Thus, the methylation status of ESR1 in adenomas was not correlated with patient age, but was associated with K-ras mutation, suggesting that methylation of ESR1 in tumors functions differently from that in normal colon mucosa. (Cancer Sci 2009; 100: 1005-1011).

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  • Ratio of Platelet Reduction is an Early Predictive Factor for the Effectiveness of Leukocytapheresis for Ulcerative Colitis Patients Reviewed

    Koji Takemoto, Motoaki Kuriyama, Jun Kato, Hideyuki Suzuki, Shin Ishikawa, Sakiko Hiraoka, Kazuhide Yamamoto

    THERAPEUTIC APHERESIS AND DIALYSIS   13 ( 1 )   6 - 13   2009.2

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    Leukocytapheresis is effective for ulcerative colitis (UC), and both peripheral leukocyte and platelet counts decrease during apheresis. While leukocyte counts increase and overshoot after finishing the apheresis procedure, platelet reduction continues even after apheresis. The aim of this study is to elucidate the impact of the overshoot of leukocyte and continuous platelet reduction on the efficacy of leukocytapheresis for UC. Leukocyte and platelet counts before and one hour after each leukocytapheresis session of 43 UC cases were examined (31 entered remission, but 12 did not). The correlation between the efficacy of leukocytapheresis and leukocyte overshoot or platelet reduction was examined. The average increase ratio of leukocytes in the initial five sessions of the responders was not significantly different from that of the non-responders (95% vs. 92%, P = 0.28). In contrast, the average decrease ratio of platelets in the initial five sessions of the responders was significantly higher than that of the non-responders (34% vs. 27%, P = 0.0041). Moreover, the platelet reduction at the third and fourth apheresis sessions in the responders was remarkably greater than that in the non-responders (33% vs. 20%, P = 0.0018). The efficiency of platelet reduction could be a predictive factor for the efficacy of leukocytapheresis.

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  • A case of small early cancer of sigmoid colon, which recurred with liver metastasis 18 months after surgical resection Reviewed

    Keita Harada, Jun Kato, Koji Takemoto, Toshio Uraoka, Sakiko Hiraoka, Hiroyuki Yanai, Kazuhide Yamamoto

    Journal of Japanese Society of Gastroenterology   106 ( 5 )   660 - 667   2009

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    A 74-year-old man was referred to our hospital with positive fecal occult blood test. Colonoscopic examination revealed a 7-mm 0-Is type polyp in the sigmoid colon. Endoscopic mucosal resection for this lesion completely removed the lesion and the histologic diagnosis was well differentiated adenocarcinoma. Cancer cells invaded the submucosa to a depth of 900μm, and vascular invasion was found. Therefore, the patient underwent additional surgical resection with lymph node dissection. During follow-up, however, serum CEA increased beyond the normal limit 18 months after surgical operation, and a 15-mm single liver metastasis was found through enhanced CT scan abdominal imaging, the FDG-PET scan, and ultrasonography. We have to pay attention to metachronous liver metastasis especially when the vascular invasion is suspected in the resected sample, even if the lesion is completely removed.

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  • Age-related methylation in normal colon mucosa differs between the proximal and distal colon in patients who underwent colonoscopy Reviewed

    Joichiro Horii, Sakiko Hiraoka, Jun Kato, Keita Harada, Kenji Kuwaki, Hideyuki Fujita, Shinichi Toyooka, Kazuhide Yamamoto

    CLINICAL BIOCHEMISTRY   41 ( 18 )   1440 - 1448   2008.12

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    Objectives: To examine the difference in the methylation status ill normal colon mucosa between the proximal and distal colon. in relation to the correlation between the methylation status of normal mucosa and characteristics of neoplasia.
    Design and methods: Paired biopsy specimens of normal mucosa from the proximal and distal colon of 82 patients who underwent colonoscopy were obtained. The methylation status of the promoter region of estrogen receptor 1 (ESR1) and myogenic differentiation 1 (MYOD1) was examined.
    Results: Normal mucosa was more highly methylated ill the distal than in the proximal colon in both ESR1 and MYOD1 loci (p&lt;0.0001 and p = 0.0009, respectively). Advanced characteristics of polyps in the distal colon were frequently observed in patients with lower methylation of ESR1 in the distal colon normal mucosa.
    Conclusions: Methylation levels in normal mucosa differ between the proximal and distal colon, and lower methylation of ESR1 in the distal colon normal mucosa may correlate with advanced features of neoplasia in the distal colon. (c) 2008 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

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  • Genetic and epigenetic alterations of Ras signalling pathway in colorectal neoplasia: analysis based on tumour clinicopathological features. International journal

    K Harada, S Hiraoka, J Kato, J Horii, H Fujita, K Sakaguchi, Y Shiratori

    British journal of cancer   97 ( 10 )   1425 - 31   2007.11

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    Activation of RAS signalling induced by K-ras/BRAF mutations is a hallmark of colorectal tumours. In addition, Ras association domain families 1 and 2 (RASSF1 and RASSF2), the negative regulators of K-ras, are often inactivated by methylation of the promoter region in those tumours. However, reports showing differences in the occurrence of these alterations on the basis of tumour characteristics have been scarce. We analysed K-ras/BRAF mutations and the methylation status of RASSF1 and RASSF2 promoter regions in 120 colorectal adenomas with respect to their clinicopathological features. K-ras/BRAF mutations and RASSF2 methylation were observed in 49 (41%) and 30 (25%) of the samples, respectively, while RASSF1 methylation was observed in only 3 (2.5%). Adenomas with RASSF2 methylation often carried K-ras/BRAF mutations simultaneously (22 out of 30, P<0.01). Multivariate analysis revealed that the concomitance of these alterations was frequently observed in serrated adenomas (odds ratio (OR) 11.11; 95% confidence interval (CI) 1.96-63.00), but rarely in adenomas located in the sigmoid or descending colon (OR 0.13; 95% CI 0.03-0.58). A comparison between adenomas and cancers showed a significantly higher prevalence of these alterations in cancers than in adenomas in the proximal colon (58 vs 27%, P=0.02). Frequency and the time point of the occurrence of Ras signalling disorders differ according to colorectal neoplasia's characteristics, particularly the location.

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  • Decreased expression of hMLH1 correlates with reduced 5-fluorouracil-mediated apoptosis in colon cancer cells Reviewed

    Hideyuki Fujita, Jun Kato, Joichiro Horii, Keita Harada, Sakiko Hiraoka, Hidenori Shiraha, Kohsaku Sakaguchi, Yasushi Shiratori

    ONCOLOGY REPORTS   18 ( 5 )   1129 - 1137   2007.11

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    Patients with sporadic microsatellite instable colorectal cancers, in most of which the function of the hMLH1 mismatch repair gene is impaired, do not gain a survival benefit from 5-fluorouracil (5-FU)-based chemotherapy. However, the effect of hMLH1 on the cytotoxicity induced by 5-FU has not yet been sufficiently confirmed. In this study, we assessed the effect of hMLH1 on cytotoxicity and apoptosis induced by 5-FU using newly developed cell lines. We constructed two cell lines: SW480 (originally hMLH1-proficient), in which the expression of hMLH1 was reduced using a small interfering RNA (siRNA) technique, and HCT116 (originally hMLH1-deficient), in which the expression of hMLH1 can be regulated by doxycycline. Using these, cell lines, a clonogenic survival assay, 4',6-diamidino-2-phenylindole (DAPI) staining and an Annexin-V assay were performed. Moreover, the incorporation of 5-FU into DNA was determined using tritium-labeled 5-FU. In both of our two cell lines, hMLH1-deficient cells exhibited approximately 2.4-fold clonal surviving fraction compared to hMLH1-proficient cells for 10 days after the administration of 5-FU. Additionally, hMLH1-deficient cells treated with 5-FU exhibited 34-45% less apoptosis than hMLH1-proficient cells according to the results of DAPI staining and Annexin-V assay. Furthermore, hMLH1-deficient cells treated with 5-FU exhibited an approximately 2-fold greater incorporation of 5-FU into DNA than control cells, suggesting that the recognition of 5-FU-incorporated DNA is impaired in hMLH1-deficient cells, resulting in reduced apoptosis. Our conclusions were that decreased expression of hMLH1 in colon cancer cells reduced the apoptosis induced by 5-M, suggesting that hMLH1 is a key determinant of 5-FU chemosensitivity.

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  • Centrifugal leukocytapheresis therapy for ulcerative colitis without concurrent corticosteroid administration Reviewed

    H Okada, R Takenaka, S Hiraoka, C Makidono, S Hori, J Kato, H Okazaki, H Kawamoto, M Mizuno, Y Shiratori

    THERAPEUTIC APHERESIS AND DIALYSIS   10 ( 3 )   242 - 246   2006.6

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    Corticosteroid administration is an important therapy for active ulcerative colitis. However, long-term corticosteroid use is associated with serious complications such as osteoporosis, diabetes, and growth retardation. The effect of combination therapy corticosteroid plus leukocytapheresis has been previously reported, but that of leukocytapheresis with no corticosteroid is unknown. We carried out a preliminary study of six patients (two men and four women) with active ulcerative colitis (severe in two, moderately severe in four) who did not respond to 5-aminosalicylate derivatives, but refused corticosteroid use. Centrifugal leukocytapheresis was carried out once per week totaling four sessions per course. Treatment was considered effective when patients experienced clinical remission, which was defined as a frequency of diarrhea of four times or less and absence of visible blood in the stool, after one course. Leukocytapheresis was effective in five of six patients(83%). With cases stratified by severity, both severe cases and three of four moderately severe cases showed effectiveness. Clinical activity scores according to Lichtiger et al. in cases where leukocytapheresis was effective decreased from 9.8 to 6.6 at 1 week (P &lt; 0.0001), declining further 2.4 at the end of the course. No obvious complications of leukocytapheresis were noted except for a decrease in hemoglobin by 1 g/dL. Centrifugal leukocytapheresis without corticosteroid treatment can induce remission in patients with active ulcerative colitis, and might be particularly beneficial for patients in whom adverse effects preclude the use of corticosteroids.

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  • Therapeutic efficacy of leukocytapheresis in a pregnant woman with severe active ulcerative colitis Reviewed

    H. Okada, C. Makidono, R. Takenaka, S. Hiraoka, A. Fujiwara, J. Kato, Y. Kawahara, H. Kawamoto, M. Mizuno, Y. Shiratori

    DIGESTION   74 ( 1 )   15 - 18   2006

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    Leukocytapheresis has recently been used to induce remission in patients with ulcerative colitis (UC) who fail to respond to corticosteroids. We could not find a report in the literature on leukocytapheresis for UC with gestational exacerbation. We have recently encountered this unique condition and report the details here. A 30-year-old Japanese woman with left-sided severe UC was corticosteroid-dependent and had recurrence of the active disease during tapering of corticosteroid. She declined any dose increase and the use of any immunosuppressive agent because she was in the 13th week of pregnancy. Then, concomitant leukocytapheresis was performed without increasing the corticosteroid dose. Recovery was rapid and dramatic. Mucous and bloody stool decreased after the first session, and she had remission 2 weeks later. She underwent a total of four sessions without complications. After 6 weeks, she was discharged from our hospital and underwent maintenance treatment as an outpatient with mesalazine and corticosteroid tapering. Subsequently, she gave birth to a healthy baby girl by an uncomplicated vaginal delivery while keeping the remitted stage of UC. Copyright (c) 2006 S. Karger AG, Basel.

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  • Stool decay-accelerating factor as a marker for monitoring the disease activity during leukocyte apheresis therapy in patients with refractory ulcerative colitis Reviewed

    H Kohno, M Mizuno, J Nasu, C Makidono, S Hiraoka, T Inaba, K Yamamoto, H Okada, T Fujita, Y Shiratori

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   20 ( 1 )   73 - 78   2005.1

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    Background and Aims: We have shown previously that concentrations of stool decay-accelerating factor (DAF; CD55), a complement regulatory protein, in patients with ulcerative colitis (UC) are increased in relation to the severity of the colonic mucosal inflammation. In the present study, we evaluated the usefulness of stool DAF as a marker for monitoring disease activity in patients with steroid-resistant active UC being treated with leukocyte apheresis performed with a centrifugal cell separator.
    Methods: Twenty-one patients with active and steroid-resistant UC were treated with leukzocyte apheresis once a week for 4 weeks, and stool DAF concentrations were determined weekly by immunoassay.
    Results: After treatment, 11 (52%) of the 21 UC patients went into remission. Stool DAF concentrations decreased promptly and steadily in the responsive group. The difference reached statistical significance as soon as after the second apheresis session (P &lt; 0.003), compared with values before the therapy and corresponding values in the non-responsive group (P = 0.024). The reduction in stool DAF concentrations after the second apheresis session was significantly greater in the responsive group (median 90%, range 22-90%) than in the non-responsive group (median -13%. range -307-94%) (P = 0.008). Hematological tests, that is, white blood cell (WBC) count and C-reactive protein, declined significantly during the apheresis therapy, but not in relation to therapeutic response.
    Conclusion: Stool DAF concentration is a useful marker in the clinical response of UC patients to treatment with leukocyte apheresis. (C) 2005 Blackwell Publishing Asia Pty Ltd.

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  • Complement regulatory proteins in normal human esophagus and esophageal squamous cell carcinoma Reviewed

    K Shimo, M Mizuno, J Nasu, S Hiraoka, C Makidono, H Okazaki, K Yamamoto, H Okada, T Fujita, Y Shiratori

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   19 ( 6 )   643 - 647   2004.6

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    Background: Altered expression of three complement regulatory proteins, decay-accelerating factor (CD55), membrane cofactor protein (CD46) and homologous restriction factor 20 (CD59) has been identified in human gastrointestinal malignancies, but their expression in esophageal cancer has not been described. Therefore the purpose of the present paper was to study the distribution of these proteins in human normal and malignant esophageal mucosa.
    Methods and results: In the normal esophageal mucosa, CD55 predominantly stained on the cell membrane of squamous epithelium in the superficial and prickle cell layers, whereas CD46 most intensely stained on the cell membrane in the basal and parabasal cell layers. In contrast to this reciprocal expression of CD55 and CD46, CD59 was broadly distributed on the cell membrane in all layers. In the esophageal squamous cell carcinoma, CD55 staining was intense in the stroma but was negligible in the cancer cells. In contrast, CD46 and CD59 stained almost uniformly on the tumor cell membrane. There was a significant difference in the intensity of the staining of CD55 and CD46 among cells in various layers of normal esophageal mucosa and esophageal carcinoma cells, but not in the staining of CD59. Similar expression patterns of the three complement regulatory proteins in carcinoma cells and in normal epithelium in the basal and parabasal cell layers were observed.
    Conclusions: These observations on the expression of the three complement regulatory proteins would help understanding of the host immune responses involving the complement system against esophageal squamous cell carcinoma. (C) 2004 Blackwell Publishing Asia Pty Ltd.

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  • Increased serum concentrations and surface expression on peripheral white blood cells of decay-accelerating factor (CD55) in patients with active ulcerative colitis Reviewed

    C Makidono, M Mizuno, J Nasu, S Hiraoka, H Okada, K Yamamoto, T Fujita, Y Shiratori

    JOURNAL OF LABORATORY AND CLINICAL MEDICINE   143 ( 3 )   152 - 158   2004.3

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    Inflammatory stimuli induce expression and release of decay-accelerating factor (DAF), a complement-regulatory protein present on peripheral-blood cells. Therefore, in ulcerative colitis (UC), an inflammatory colonic disease in which activated leukocytes are involved, DAF may be released from leukocytes into the circulation. In this study we compared serum DAF concentrations and surface DAF expression on peripheral-blood cells in patients with UC with disease activity. Peripheral-blood samples were obtained from 60 patients with UC (30 with active and 30 with inactive disease) and 19 healthy volunteers. Serum DAF concentrations were determined by means of immunoassay, and surface DAF expression on blood cells was examined with the use of flow cytometry. Serum DAF concentrations in patients with active disease (mean 48.6 ng/mL) were significantly higher than those in patients whose disease was in remission (33.3 ng/mL; P = .0003) and those in healthy controls (32.3 ng/mL; P = .0007). Surface DAF expression on neutrophils, CD14+ monocytes, and subsets of lymphocytes in patients with active UC was significantly increased compared with that in patients with UC in remission and in healthy controls. The increased serum DAF concentrations and surface DAF expression on leukocyte fractions in patients with active disease fell to significantly lower levels when the disease had gone into remission after medical therapy. Serum DAF concentrations are increased in UC patients in relation to disease activity. The likely source of increased DAF concentrations is peripheral-blood leukocytes that have been activated as part of the UC disease process.

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  • Difference in Ulex europaeus agglutinin I-binding activity of decay-accelerating factor detected in the stools of patients with colorectal cancer and ulcerative colitis Reviewed

    H Okazaki, M Mizuno, J Nasu, C Makidono, S Hiraoka, K Yamamoto, H Okada, T Fujita, T Tsuji, Y Shiratori

    JOURNAL OF LABORATORY AND CLINICAL MEDICINE   143 ( 3 )   169 - 174   2004.3

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    Expression of decay-accelerating factor (DAF, CD55), a complement-regulatory glycoprotein, is enhanced in colorretal-cancer (CC) cells and colonic epithelium in ulcerative colitis UC, and stools from these patients contain increased amounts of DAF. Carbohydrate chains of glycoproteins are often altered during malignant transformation or inflammation. In this study, we investigated whether DAF molecules in patients with CC and those with UC differ with respect to oligosacchadde side chains. We analyzed DAF in stools and homogenates of colonic-tissue specimens obtained from patients with CC or UC using solid-phase enzyme-linked assay and Western blotting for reactivity with the lectins Ulex europaeus agglutinin l (UEA-l), wheat-germ agglutinin, peanut agglutinin, and concanavalin A. UEA-l bound to DAF in stools from patients with UC but not in that from the stools of CC patients, as demonstrated on the solid-phase enzyme-linked assay (P &lt; .05, Mann-Whitney U test) and Western blotting. Binding of UEA-l was specifically inhibited by the addition of fucose. The difference in LEA-l reactivity with DAF was observed also in colonic-tissue homogenates from patients with UC and those with CC. DAF expressed in the mucosa and excreted into the stools of UC patients is different from that expressed in CC with regard to UEA-l reactivity. Future studies should be directed toward determining whether a qualitatively unique isoform of DAF is present, of which sugar chains are specific to CC in UC patients.

    DOI: 10.1016/j.lab.2003.11.005

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Books

  • IBD治療薬の基本と実践

    ( Role: Edit)

    文光堂  2021.10 

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    Language:Japanese

  • IBD治療薬の基本と実践 : 決定版! : 患者背景と病態から治療の次の一手を考える!

    加藤, 順, 平岡, 佐規子

    文光堂  2021.10  ( ISBN:9784830621116

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  • 初回の発症より6年後に再発したアメーバ赤痢の1例

    龍治 昭宏, 大城 勝, 笠井 健史, 宮部 欽生, 河合 良成, 平岡 佐規子

    広島医学   76 ( 10 )   359 - 359   2023.10

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  • 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   2023.9

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  • 水浸下生検後の気泡流出により診断した腸管嚢胞様気腫症の1例

    岩室 雅也, 三宅 望, 平岡 佐規子

    Gastroenterological Endoscopy   65 ( 7 )   1245 - 1245   2023.7

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    豊澤 惇希, 山崎 泰史, 平岡 佐規子

    Gastroenterological Endoscopy   65 ( Suppl.1 )   832 - 832   2023.4

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    Language:Japanese   Publisher:(一社)日本消化器内視鏡学会  

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  • 胃内の付着薬剤の除去に回収ネットによる擦過が有用であった1例

    岩室 雅也, 竹井 健介, 平岡 佐規子

    Gastroenterological Endoscopy   65 ( 4 )   375 - 375   2023.4

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    青山 祐樹, 井口 俊博, 平岡 佐規子

    Gastroenterological Endoscopy   65 ( Suppl.1 )   728 - 728   2023.4

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  • 【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   2023.3

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    <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.

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  • 胃癌検診の現状と将来 胃がん内視鏡検診でのリスク層別化における胃炎京都分類の有用性

    平井 亮佑, 水野 元夫, 平井 麻美, 下立 雄一, 平岡 佐規子

    日本胃癌学会総会記事   95回   194 - 194   2023.2

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  • 【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   2022.12

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    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)

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  • 下部消化管の良性狭窄に対する内視鏡治療の現状(動画付き)

    原田 馨太, 平岡 佐規子, 岡田 裕之

    Gastroenterological Endoscopy   64 ( 12 )   2472 - 2488   2022.12

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    後天的な消化管狭窄の成因は,進行癌,炎症治癒後の瘢痕,内視鏡治療後の瘢痕,外科手術の吻合など,一様でない.ところが消化管狭窄が治療の対象となるとき,その理由は一様で,通過障害を起こしたときである.上部消化管の場合は食物を,下部消化管の場合は消化吸収された後の便を通すための治療が行われる.切除適応の進行癌であれば,狭窄の解除とともに根治を目指した外科手術が第一選択として行われることがあるが,多くのケースで狭窄解除を目的とした外科手術は最後の切り札である.とりわけ良性狭窄に対しては外科手術回避のために,機械的な拡張術が第一選択の方法としてかねてから行われてきた.本稿では,下部消化管の狭窄に対して,内科的に行われる,特に内視鏡を用いた拡張術について,ブジー,バルーン拡張術,Radial incision and cutting(RIC)の順に,現状を述べる.かつてと比べて,内視鏡下に狭窄部が拡張される様子を確認しながら施行することが圧倒的に多くなっているが,機械的拡張術の方法論じたいは長年画期的なブレイクスルーがなく代わり映えしない.現状の抱えている問題点や将来展望についてもあわせて述べる.(著者抄録)

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    Other Link: https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00192&link_issn=&doc_id=20221223280002&doc_link_id=10.11280%2Fgee.64.2472&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.64.2472&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   2022.11

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    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)

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  • 十二指腸腫瘍に対する診断と治療の現状 当院における非乳頭部十二指腸表在性腫瘍に対する治療戦略

    山崎 泰史, 河原 祥朗, 平岡 佐規子, 菊地 覚次, 藤原 俊義

    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   118回・129回   61 - 61   2022.11

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  • 手技の解説 クローン病におけるダブルバルーン内視鏡下逆行性造影の実際

    井口 俊博, 川野 誠司, 平岡 佐規子

    Gastroenterological Endoscopy   64 ( 10 )   2308 - 2316   2022.10

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    クローン病患者の7割以上が小腸病変を有するとされ,小腸病変のモニタリングとその制御は患者のQOLに直結する.従ってクローン病診療では,全小腸を高精度でかつ手軽に,そして低侵襲にモニタリングすることが求められるが,残念ながらすべてを兼ね備えた検査やマーカーは未だ存在しない.ダブルバルーン内視鏡検査は,クローン病小腸病変に対するモニタリング検査の1つとして,また時に内視鏡的拡張術目的に広く使用されている.当科ではダブルバルーン内視鏡検査の際に通常の観察に加えて先端バルーンを拡張させて逆行性造影を行い,それまでは難しかった深部小腸の評価をルーチンで行っている.本稿では,クローン病小腸病変に対するダブルバルーン内視鏡下逆行性造影の手順やコツを解説する.(著者抄録)

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  • 【Evidence & Consensusで押さえる IBDの治療薬 最新版】基本薬 ステロイドの適正使用

    平岡 佐規子

    薬事   64 ( 12 )   2473 - 2477   2022.9

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    <Key Point>●副腎皮質ステロイド(ステロイド)は中等症以上の潰瘍性大腸炎(UC)および活動期クローン病(CD)の寛解導入治療として有効性を示し、即効性も期待される薬剤である。●効果を見極めるためにも、重症度に応じた適切な用量で開始することが重要である。●開始後は、1~2週間ごとを目安に徐々に減量し(全身投与のプレドニゾロンの場合)、確実に離脱する。●効果が不十分であるステロイド抵抗性、減量中止で再燃を来すステロイド依存性の患者は、難治性として次のステップに進む。●UC、CDともに寛解維持治療としてのエビデンスはなく、副作用の懸念から長期投与は避ける。(著者抄録)

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  • 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   2022.6

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  • 大腸腫瘍性病変に対する内視鏡治療の最前線 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, 原田 馨太, 平岡 佐規子, 岡田 裕之

    日本消化器内視鏡学会中国支部例会   128回   79 - 79   2022.5

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  • 【図説「胃と腸」画像診断用語集2022】疾患 食道 食道炎症性疾患(IBD関連)

    平岡 佐規子

    胃と腸   57 ( 5 )   582 - 582   2022.5

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  • 5-ASA不耐症への対応 成人IBDにおける5-ASA不耐の実態

    加藤 順, 平岡 佐規子

    日本小児栄養消化器肝臓学会雑誌   36 ( 1 )   34 - 34   2022.4

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  • dysplasiaを有する大腸鋸歯状病変の診断のポイント

    竹井 健介, 原田 馨太, 岡田 裕之, 豊澤 惇希, 青山 祐樹, 山本 峻平, 安富 絵里子, 井川 翔子, 竹内 桂子, 山崎 泰史, 井口 俊博, 衣笠 秀明, 平岡 佐規子, 田中 健大

    Gastroenterological Endoscopy   64 ( Suppl.1 )   778 - 778   2022.4

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  • 【炎症性腸疾患update-診断・治療の最新知見-】炎症性腸疾患の治療 炎症性腸疾患のマネージメント Special situation 妊娠・出産・授乳中のマネージメント

    平岡 佐規子

    日本臨床   80 ( 3 )   475 - 480   2022.3

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  • 潰瘍性大腸炎におけるタクロリムス療法の最適症例を考える

    井川 翔子, 平岡 佐規子, 岡田 裕之

    日本消化器病学会雑誌   119 ( 臨増総会 )   A306 - A306   2022.3

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  • 食でどこまでIBDの予防・治療にせまれるか?

    溝口 充志, 金井 隆典, 杉本 健, 平岡 佐規子

    消化器病学サイエンス   6 ( 1 )   1 - 8   2022.3

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  • dysplasiaを有する大腸鋸歯状病変の診断のポイント

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

    Gastroenterological Endoscopy (Web)   64 ( Supplement1 )   2022

  • Usefulness of transabdominal ultrasonography in evaluating the activity of Crohn’s disease

    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 Supplement   49   2022

  • PROCEDURE FOR RETROGRADE CONTRAST THROUGH DOUBLE-BALLOON ENTEROSCOPY IN CROHN’S DISEASE

    井口俊博, 川野誠司, 平岡佐規子

    Gastroenterological Endoscopy (Web)   64 ( 10 )   2022

  • 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(Web)   119   2022

  • 免疫・アレルギー・炎症 潰瘍性大腸炎診療におけるバイオマーカー 新規バイオマーカーLeucin rich α2-glycoproteinの検討も含め

    平岡 佐規子

    リンパ学   44 ( 2 )   86 - 90   2021.12

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    潰瘍性大腸炎患者182例262検査(男性94例、女性88例、年齢中央値48歳)を対象に、新規バイオマーカーであるLeucin rich α2-glycoprotein(LRG)の有用性について検討した。既存のバイオマーカーと比較した結果、内視鏡活動性と内視鏡的寛解の検出能は、血清マーカーであるLRGとCRPでは同等であり、血清マーカーより便中マーカーであるFIT、FCalの方が高い検出能を示していた。一方、時間経過を経た内視鏡的炎症の変化を検出するバイオマーカーとしては、血清マーカーのLRGと便中マーカーのFCalの有用性が高いと考えられた。

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  • 非典型的な発症を呈した潰瘍性大腸炎合併壊疽性膿皮症の1例

    嶋崎 岳, 青山 祐樹, 井口 俊博, 平岡 佐規子, 竹井 健介, 井川 翔子, 山本 峻平, 安富 絵里子, 大森 正泰, 竹内 桂子, 山崎 泰史, 衣笠 秀明, 原田 馨太, 岡田 裕之

    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   116回・127回   78 - 78   2021.11

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  • 腎移植後に発症した巨大な大腸潰瘍の一例

    山下 航矢, 山崎 泰史, 西村 慎吾, 荒木 元朗, 青山 祐樹, 竹井 健介, 井川 翔子, 安富 絵里子, 大森 正泰, 井口 俊博, 衣笠 秀明, 原田 馨太, 平岡 佐規子, 岡田 裕之

    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   116回・127回   69 - 69   2021.11

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  • 炎症性腸疾患患者における月経に関連する症状の変化および挙児希望に関わる検討

    安富 絵里子, 平岡 佐規子, 青山 祐樹, 井川 翔子, 山本 峻平, 大森 正泰, 山崎 泰史, 井口 俊博, 衣笠 秀明, 川野 誠司, 原田 馨太, 岡田 裕之

    日本高齢消化器病学会誌   24 ( 1 )   195 - 195   2021.7

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  • 多発深掘れ潰瘍を呈したメサラジン不耐潰瘍性大腸炎の一例

    竹井 健介, 井口 俊博, 青山 祐樹, 井川 翔子, 安富 絵里子, 山本 峻平, 大森 正康, 岡 昌平, 山崎 泰史, 衣笠 秀明, 原田 馨太, 平岡 佐規子, 岡田 裕之

    日本消化器内視鏡学会中国支部例会   126回   61 - 61   2021.6

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  • Effectiveness of transabdominal ultrasonography to detection of small intestinal stenosis in patients with Crohn’s disease

    竹内桂子, 井口俊博, 高原政宏, 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 Supplement   115回   59 - 59   2021.5

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  • CTコロノグラフィー検査が診断に有用であった盲腸子宮内膜症の2例

    小橋 真由, 岩室 雅也, 田中 健大, 杉原 雄策, 原田 馨太, 平岡 佐規子, 近藤 喜太, 岡田 裕之

    Gastroenterological Endoscopy   63 ( Suppl.1 )   966 - 966   2021.4

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  • IBD診療における内視鏡の意義 新規バイオマーカーLRG クローン病の日常診療でいかに使うか?

    井口 俊博, 平岡 佐規子, 岡田 裕之

    Gastroenterological Endoscopy   63 ( Suppl.1 )   803 - 803   2021.4

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  • 潰瘍性大腸炎診療におけるバイオマーカーの位置づけを考える 新規LRGも含め

    安富 絵里子, 平岡 佐規子, 竹井 健介, 井川 翔子, 山本 峻平, 大森 正泰, 岡 昌平, 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   118 ( 臨増総会 )   A360 - A360   2021.3

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  • SAPHO症候群に対しイキセキズマブ投与後に腸炎を発症した1例

    森 悠記, 倉岡 紗樹子, 竹井 健介, 井川 翔子, 安富 絵里子, 山本 峻平, 大森 正泰, 岡 昌平, 山崎 泰史, 井口 俊博, 衣笠 秀明, 原田 馨太, 平岡 佐規子, 岡田 裕之

    日本消化管学会雑誌   5 ( Suppl. )   319 - 319   2021.1

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  • 十二指腸・大腸腫瘍に対する内視鏡治療の最前線-cold snare polypectomyからunderwater EMR、ESDまで- 10-20mmの大腸腫瘍性病変に対する内視鏡的切除法の切除深度の検討 EMR、underwaterEMR、ESD、hybrid ESD/precutting EMRの比較

    大森 正泰, 山崎 泰史, 竹井 健介, 井川 翔子, 安富 絵里子, 山本 峻平, 岡 昌平, 井口 俊博, 衣笠 秀明, 原田 馨太, 平岡 佐規子, 岡田 裕之

    日本消化管学会雑誌   5 ( Suppl. )   208 - 208   2021.1

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  • クローン病小腸狭窄病変に対するダブルバルーン内視鏡下バルーン拡張術の有効性の検討

    井口 俊博, 井川 翔子, 安富 絵里子, 岡 昌平, 川野 誠司, 平岡 佐規子, 岡田 裕之

    日本消化管学会雑誌   5 ( Suppl. )   129 - 129   2021.1

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  • 新規バイオマーカーLRG:クローン病の日常診療でいかに使うか?

    井口俊博, 平岡佐規子, 平岡佐規子, 岡田裕之

    Gastroenterological Endoscopy (Web)   63 ( Supplement1 )   2021

  • CTコロノグラフィー検査が診断に有用であった盲腸子宮内膜症の2例

    小橋真由, 岩室雅也, 田中健大, 杉原雄策, 原田馨太, 平岡佐規子, 近藤喜太, 岡田裕之

    Gastroenterological Endoscopy (Web)   63 ( Supplement1 )   2021

  • 潰瘍性大腸炎診療におけるバイオマーカーの位置づけを考える-新規LRGも含め-

    安富絵里子, 平岡佐規子, 竹井健介, 井川翔子, 山本峻平, 大森正泰, 岡昌平, 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(Web)   118   2021

  • Ixekizumab-induced pancolitis in a patient with SAPHO syndrome

    森悠記, 倉岡紗樹子, 竹井健介, 井川翔子, 安富絵里子, 山本峻平, 大森正泰, 岡昌平, 山崎泰史, 井口俊博, 衣笠秀明, 原田馨太, 平岡佐規子, 岡田裕之

    日本消化管学会雑誌   5 ( Supplement )   2021

  • Resection depth of 4 endoscopic resection methods for 10-20mm colorectal lesions-Comparison of EMR, UEMR, ESD and hybrid ESD/precutting EMR-

    大森正泰, 山崎泰史, 竹井健介, 井川翔子, 安富絵里子, 山本峻平, 岡昌平, 井口俊博, 衣笠秀明, 原田馨太, 平岡佐規子, 岡田裕之

    日本消化管学会雑誌   5 ( Supplement )   59 - 59   2021

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  • Usefulness of endoscopic balloon dilation through double-balloon enteroscopy in patients with Crohn’s disease with small bowel stenosis

    井口俊博, 井川翔子, 安富絵里子, 岡昌平, 川野誠司, 平岡佐規子, 岡田裕之

    日本消化管学会雑誌   5 ( Supplement )   2021

  • 周期的発熱,及び腹痛精査中に診断された正中弓状靭帯圧迫症候群の1例

    乃美優孝, 井口俊博, 青山祐樹, 竹井健介, 安富絵里子, 井川翔子, 大森正泰, 岡昌平, 竹内桂子, 山崎泰史, 衣笠秀明, 原田馨太, 平岡佐規子, 岡田裕之, 徳増一樹, 大塚文男, 矢野修也, 菊地覚次, 坂本真樹

    日本消化器病学会中国支部例会プログラム・抄録集   115th   2021

  • イキセキズマブ投与後に重症腸炎を発症したSAPHO症候群の1例

    倉岡 紗樹子, 竹井 健介, 井川 翔子, 安富 絵里子, 山本 峻平, 大森 正泰, 岡 昌平, 山崎 泰史, 井口 俊博, 衣笠 秀明, 原田 馨太, 平岡 佐規子, 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   114回   74 - 74   2020.11

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  • 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   2020.10

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  • 難治性潰瘍性大腸炎患者における寛解導入治療後の便中マーカー推移の解析

    平岡 佐規子, 山本 俊平, 安富 絵里子, 大森 正泰, 岡 昌平, 平井 麻美, 山崎 康史, 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 ( 臨増大会 )   A779 - A779   2020.10

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  • 3-5mmの大腸微小ポリープに対する拡大観察を併用したCold Forceps Polypectomy

    山崎 泰史, 原田 馨太, 岡田 裕之, 山本 峻平, 安富 絵里子, 岡 昌平, 平井 麻美, 井口 俊博, 衣笠 秀明, 平岡 佐規子

    Gastroenterological Endoscopy   62 ( Suppl.1 )   1315 - 1315   2020.8

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  • 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   2020.7

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  • 悪性黒色腫の遅発性転移により小腸重積をきたした1例

    林 里美, 衣笠 秀明, 山本 峻平, 大森 正泰, 安富 絵里子, 岡 昌平, 山崎 泰史, 井口 俊博, 川野 誠司, 原田 馨太, 平岡 佐規子, 田中 健大, 寺石 文則, 山崎 修, 岡田 裕之

    日本消化器内視鏡学会中国支部例会   124回   41 - 41   2020.6

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  • 炎症性腸疾患における診断・治療の現状と展望 当院における難治性潰瘍性大腸炎に対する経口タクロリムス療法の短期および長期成績

    井川 翔子, 井口 俊博, 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   113回   69 - 69   2020.5

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  • 肝細胞癌に対するシスプラチン肝動注化学療法後に大腸炎を発症した一例

    山本 峻平, 大西 秀樹, 衣笠 秀明, 神崎 洋光, 岩室 雅也, 原田 馨太, 川野 誠司, 平岡 佐規子, 河原 祥朗, 岡田 裕之

    日本消化管学会雑誌   4 ( Suppl. )   291 - 291   2020.1

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  • 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   2020.1

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  • 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(Web)   117   2020

  • 難治性潰瘍性大腸炎患者における寛解導入治療後の便中マーカー推移の解析

    平岡佐規子, 山本俊平, 安富絵里子, 大森正泰, 岡昌平, 平井麻美, 山崎康史, 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(Web)   117   2020

  • 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, 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(Web)   117   2020

  • 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 ( Supplement )   2020

  • 3-5mmの大腸微小ポリープに対する拡大観察を併用したCold Forceps Polypectomy

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

    Gastroenterological Endoscopy (Web)   62 ( Supplement1 )   2020

  • 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   2019.10

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  • 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   2019.10

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  • IBDのスペシャルシチュエーションをどう診るか?(第1回) 妊娠・出産を希望するIBD患者さんをどう診るか?(その1)

    平岡 佐規子

    IBD Research   13 ( 3 )   170 - 172   2019.9

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  • 【IBD類縁疾患を考える】8番染色体異常(trisomy 8)を伴う骨髄異形成症候群(MDS)に合併する腸炎

    川野 誠司, 平岡 佐規子, 井口 俊博, 岡田 裕之

    消化器・肝臓内科   6 ( 2 )   115 - 120   2019.8

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  • 【実地内科医のための潰瘍性大腸炎診療ABC】special situationの治療・将来展望 妊娠・出産

    安富 絵里子, 平岡 佐規子, 岡田 裕之

    診断と治療   107 ( 7 )   849 - 853   2019.7

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    &lt;Headline&gt;1 炎症性腸疾患(IBD)は若年者に好発する疾患であり、妊娠・出産は女性IBD患者が遭遇しうる重要なイベントの1つである。2 多くのIBDの治療薬は妊娠中も継続が可能であり、薬剤の影響よりも疾患の活動性が妊孕率の低下や妊娠中のイベントの増加のリスクに寄与する。3 病勢が安定しないうちに無計画に妊娠したり、薬に対する過剰な不安により治療を中断して病状を悪化させたり、自ら妊娠を諦めてしまうことがないよう情報提供は早めに行うべきである。(著者抄録)

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  • 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   2019.5

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  • 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   2019.5

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  • 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   2019.5

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  • 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   2019.5

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  • 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   2019.5

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  • 重症/難治性潰瘍性大腸炎における当院の手術症例から内科と外科の連携を考える

    高原 政宏, 平岡 佐規子, 井口 俊博, 岡 昇平, 安富 絵里子, 山崎 泰史, 杉原 雄策, 衣笠 秀明, 原田 馨太, 近藤 喜太, 岡田 裕之

    日本消化器病学会雑誌   116 ( 臨増総会 )   A330 - A330   2019.3

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  • 大腸ESDにおけるクリッピングは術後経過に寄与しているか

    原田 馨太, 平井 麻美, 安富 絵里子, 岡 昌平, 山崎 泰史, 井口 俊博, 杉原 雄策, 衣笠 秀明, 高原 政宏, 平岡 佐規子, 岡田 裕之

    日本消化器病学会雑誌   116 ( 臨増総会 )   A362 - A362   2019.3

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  • 炎症性腸疾患診療のリアルワールド〜生物学的製剤に対するクリニカルクエスチョンを解決する 抗TNFα抗体製剤ナイーブの難治クローン病治療 IFXとADAはどちらを先行? 多施設共同研究サブ解析より

    井口 俊博, 平岡 佐規子, 岡田 裕之, OKAYAMA GUT STUDY GROUP

    日本消化器病学会雑誌   116 ( 臨増総会 )   A117 - A117   2019.3

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  • 急性消化管GVHDの診断における上部消化管内視鏡検査および大腸内視鏡検査の生検部位の比較検討

    杉原雄策, 平岡佐規子, 山崎泰史, 井口俊博, 衣笠秀明, 高原政宏, 原田馨太, 小川弘子, 岡田裕之, 大塚文男

    日本内科学会雑誌   108 ( Suppl. )   215 - 215   2019.2

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  • 消化管出血(静脈瘤破裂を除く)の予後不良症例の検討 急性消化管GVHDにおいて回腸末端の内視鏡所見は予後・重症度・治療反応性と関連するか?

    杉原 雄策, 平岡 佐規子, 安富 絵里子, 岡 昌平, 山崎 泰史, 井口 俊博, 衣笠 秀明, 高原 政宏, 原田 馨太, 藤井 伸治, 田中 健大, 岡田 裕之

    日本消化管学会雑誌   3 ( Suppl. )   161 - 161   2019.2

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  • ベルベリンは腸管粘膜CD4+T細胞のAMPKの活性化を介して炎症性サイトカインを制御しマウス慢性腸炎を改善させる

    高原政宏, 高木章乃夫, 平岡佐規子, 安富絵里子, 岡昌平, 平井麻美, 井口俊博, 小池和子, 岡田裕之

    日本臨床免疫学会総会プログラム・抄録集   47th   77 - 77   2019

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  • 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, 杉原雄策, 高原政宏, 高原政宏, 衣笠秀明, 衣笠秀明, 平岡佐規子

    Gastroenterological Endoscopy (Web)   61 ( Supplement1 )   2019

  • 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, 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, 高島政宏, 高島政宏, 平岡佐規子, 河原祥朗

    Gastroenterological Endoscopy (Web)   61 ( Supplement1 )   2019

  • 難治性炎症性腸管障害に関する調査研究 治療指針・ガイドラインの改定

    中村志郎, 久松理一, 仲瀬裕志, 松岡克善, 杉田昭, 池内浩基, 畑啓介, 平井郁仁, 小金井一隆, 新井勝大, 虻川大樹, 小林拓, 長沼誠, 松浦稔, 松岡克善, 猿田雅之, 畑啓介, 加藤真吾, 加藤順, 仲瀬裕志, 中村志郎, 松井敏幸, 杉田昭, 余田篤, 安藤朗, 金井隆典, 長堀正和, 樋田信幸, 穂苅量太, 渡辺憲治, 仲瀬裕志, 竹内健, 上野義隆, 新井勝大, 虻川大樹, 福島浩平, 二見喜太郎, 渡辺守, 仲瀬裕志, 内野基, 江崎幹宏, 小林拓, 猿田雅之, 新崎信一郎, 杉本健, 中村志郎, 畑啓介, 平井郁仁, 平岡佐規子, 藤井俊光, 松浦稔, 松岡克善, 井上詠

    難治性炎症性腸管障害に関する調査研究 平成30年度 総括・分担研究報告書(Web)   2019

  • 重症/難治性潰瘍性大腸炎における当院の手術症例から内科と外科の連携を考える

    高原政宏, 平岡佐規子, 井口俊博, 岡昇平, 安富絵里子, 山崎泰史, 杉原雄策, 衣笠秀明, 原田馨太, 近藤喜太, 近藤喜太, 岡田裕之

    日本消化器病学会雑誌(Web)   116   2019

  • 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 (Web)   61 ( Supplement2 )   2019

  • 大腸ESDにおけるクリッピングは術後経過に寄与しているか

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

    日本消化器病学会雑誌(Web)   116   2019

  • 抗TNFα抗体製剤ナイーブの難治クローン病治療:IFXとADAはどちらを先行?多施設共同研究サブ解析より

    井口俊博, 平岡佐規子, 岡田裕之, 井口俊博, 平岡佐規子, 岡田裕之

    日本消化器病学会雑誌(Web)   116   2019

  • 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 (Web)   61 ( Supplement2 )   2019

  • 転移性大腸癌との鑑別に苦慮した大腸の肉芽性ポリープの1例

    山崎 辰洋, 岩室 雅也, 高原 政宏, 杉原 雄策, 原田 馨太, 平岡 佐規子, 近藤 喜太, 市原 英基, 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   110回   147 - 147   2018.12

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  • 適応拡大前後における院内紹介例からみた小腸カプセル内視鏡施行内容の検討 院内への啓発活動にむけて

    川野 誠司, 岩室 雅也, 井口 俊博, 杉原 雄策, 原田 馨太, 平岡 佐規子, 岡田 裕之

    岡山医学会雑誌   130 ( 3 )   155 - 159   2018.12

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    当院でのカプセル内視鏡(VCE)施行症例のうち、院内紹介症例の特徴をそれ以外の症例と比較した。さらにVCE適応拡大前後におけるVCEの使用目的の推移、特に院内紹介例の推移を比較検討した。適応拡大前(2009年1月から2012年6月:A群)122例と拡大後(2012年7月から2016年2月:B群)292例を対象とした。VCE施行件数は2009年1月の導入以降緩やかに増加していたが、2012年の適応拡大に伴い著明に増加を認めた。原因不明消化管出血(OGIB)症例の頻度は57%から41%へと有意に低下を認める一方、overt OGIBやoccult OGIBは相対的に増加していた。院内紹介例99例の検討では、総数においては循環器内科が最も多く、次いで総合内科、血液内科など各内科系からの紹介症例が大多数を占めていた。適応拡大後に限っては総合内科が最も多くを占めていた。

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  • 高度狭窄により腸閉塞を発症したクローン病妊婦の一例

    岡昌平, 高原政宏, 平岡佐規子, 安富絵里子, 山崎泰史, 井口俊博, 杉原雄策, 衣笠秀明, 原田馨太, 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   110th   115   2018.11

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  • 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   2018.10

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  • 炎症性腸疾患における内視鏡的重症度分類とその意義 クローン病小腸狭窄病変に対するダブルバルーン内視鏡下逆行性造影とmSES-CDの手術予測能についての検討

    井口 俊博, 平岡 佐規子, 岡田 裕之

    Gastroenterological Endoscopy   60 ( Suppl.2 )   1927 - 1927   2018.10

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  • 炎症性腸疾患における内視鏡的重症度分類とその意義 クローン病小腸狭窄病変に対するダブルバルーン内視鏡下逆行性造影とmSES-CDの手術予測能についての検討

    井口 俊博, 平岡 佐規子, 岡田 裕之

    日本消化器病学会雑誌   115 ( 臨増大会 )   A507 - A507   2018.10

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  • 【一歩先を行くクローン病診療】女性特有のイベントへの対応

    平岡 佐規子, 安富 絵里子, 岡 昌平, 山崎 泰史, 井口 俊博, 杉原 雄策, 高原 政宏, 原田 馨太, 川野 誠司, 近藤 喜太, 岡田 裕之

    消化器・肝臓内科   4 ( 2 )   113 - 119   2018.8

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  • MTF(male to female)性同一性障害患者に対する内視鏡医の関わり

    原田馨太, 安富絵里子, 岡昌平, 山崎康史, 杉原雄策, 杉原雄策, 衣笠秀明, 高原政宏, 高原政宏, 平岡佐規子, 難波祐三郎, 難波祐三郎, 岡田裕之

    日本高齢消化器病学会誌   21 ( 1 )   97 - 97   2018.7

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  • 【IBDの類縁疾患を知り、鑑別する!】8番染色体異常(trisomy 8)を伴う骨髄異形成症候群に合併する多発潰瘍性腸炎

    川野 誠司, 平岡 佐規子, 岡田 裕之

    IBD Research   12 ( 2 )   98 - 103   2018.6

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    近年8番染色体異常(trisomy 8)が関与する骨髄異形成症候群と腸管ベーチェット病(BD)様多発潰瘍の合併症例の報告が増加し、その臨床像が明らかとなってきてきている。とくに腸管病変の内視鏡画像の詳細な検討がなされるようになったきたことで通常の腸管BDとの相違点が指摘されるようになり、独自の疾患概念として認識されつつある。一方でいまだ確立された治療方針は存在せず、予後も不良なのが現状である。消化器内科医は本疾患を疑った場合、血液内科医や膠原病内科医などと協力して正確に診断し、適切な対処をおこなう必要があるとともに、今後新たな治療法についても検討していく必要がある。(著者抄録)

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  • 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   2018.4

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  • 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   2018.4

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  • 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   2018.4

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  • 【炎症性腸疾患診療の最前線】炎症性腸疾患の活動性と粘膜治癒評価におけるバイオマーカーの有用性

    平岡 佐規子, 加藤 順, 岡田 裕之

    日本消化器病学会雑誌   115 ( 3 )   262 - 271   2018.3

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    炎症性腸疾患は慢性疾患であり、生涯を通じ疾患活動性の評価が必要である。腸管炎症の評価の基準は内視鏡検査であるが、頻回の施行は避けたく、代替となるバイオマーカーが必須である。最近本邦でも便中カルプロテクチン(Fcal)が保険収載され、便中マーカーが注目されている。Fcalは欧米で広く利用されており、炎症性腸疾患の疾患活動性との関連、機能性疾患との鑑別に関しエビデンスも豊富である。一方、本邦から発信した免疫学的便潜血検査は、特に潰瘍性大腸炎の粘膜治癒予測においてはFcalより優れている。その他、血液マーカーでは、CRPなどの有用性が報告されているが、新規バイオマーカーの開発も期待される。(著者抄録)

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  • クローン病の抗TNFα抗体治療の長期予後 インフリキシマブ先行例とアダリムマブ先行例を比較する多施設共同研究

    井口 俊博, 平岡 佐規子, 高橋 索真, 高木 慎二郎, 豊川 達也, 竹本 浩二, 宮池 次郎, 藤本 剛, 東 玲治, 森藤 由記, 名和 徹, 井上 雅文, 喜多 雅英, 鈴木 誠祐, 岡田 裕之, OKAYAMA GUT STUDY GROUP

    日本消化器病学会雑誌   115 ( 臨増総会 )   A317 - A317   2018.3

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  • Peroral Endoscopic Myotomy(POEM,経口内視鏡的筋層切開術)の当院導入経緯と治療成績の検討

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

    日本消化管学会雑誌   2 ( Supplement )   136 - 136   2018.2

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  • 難治性炎症性腸管障害に関する調査研究 炎症性腸疾患患者におけるチオプリン関連副作用とNUDT15遺伝子多型との相関性に関する多施設共同研究(MENDEL Study)

    角田洋一, 木内喜孝, 中村志郎, 高川哲也, 花井洋行, 池谷賢太郎, 櫻庭裕丈, 西田淳史, 佐々木誠人, 岡庭紀子, 久松理一, 小林拓, 小野寺馨, 石黒陽, 篠崎大, 長沼誠, 平岡佐規子, 荒木寛司, 佐々木悠, 志賀永嗣, 本谷聡, 小野寺基之, 松岡克善, 藤谷幹浩, 佐藤雄一郎, 桂田武彦, 梁井俊一, 穂苅量太, 石原俊治, 新井勝大, 野口光徳, 中川倫夫, 加藤順, 杉田昭, 松浦稔, 遠藤克哉, 内藤健夫, 諸井林太郎, 黒羽正剛, 木村智哉, 金澤義丈, 安藤朗, 鈴木康夫, 下瀬川徹

    難治性炎症性腸管障害に関する調査研究 平成29年度 総括・分担研究報告書   231‐233   2018

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  • 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 (Web)   60 ( Supplement1 )   2018

  • 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, 平岡佐規子, 安富絵里子, 岡昌平, 高原政宏, 岡田裕之, 岡田裕之

    日本アフェレシス学会雑誌   37 ( Supplement )   2018

  • 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 (Web)   60 ( Supplement1 )   2018

  • 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 (Web)   60 ( Supplement1 )   2018

  • クローン病小腸狭窄病変に対するダブルバルーン内視鏡下逆行性造影とmSES-CDの手術予測能についての検討

    井口俊博, 平岡佐規子, 岡田裕之

    Gastroenterological Endoscopy (Web)   60 ( Supplement2 )   2018

  • 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 (Web)   60 ( Supplement2 )   2018

  • 肝移植後も消化管出血を繰り返した先天性胆道閉鎖症の一例

    石田正也, 川野誠司, 岡本雄貴, 大林由佳, 濱田健太, 馬場雄己, 榮浩行, 後藤田達洋, 安部真, 井口俊博, 神崎洋光, 岩室雅也, 平岡佐規子, 岡田裕之, 河原祥朗, 楳田祐三, 八木孝仁

    日本消化器病学会中国支部例会プログラム・抄録集   110th   2018

  • クローン病の抗TNFα抗体治療の長期予後 インフリキシマブ先行例とアダリムマブ先行例を比較する多施設共同研究

    井口俊博, 井口俊博, 平岡佐規子, 平岡佐規子, 高橋索真, 高橋索真, 高木慎二郎, 豊川達也, 竹本浩二, 宮池次郎, 藤本剛, 東玲治, 森藤由記, 名和徹, 井上雅文, 喜多雅英, 鈴木誠祐, 岡田裕之, 岡田裕之

    日本消化器病学会雑誌(Web)   115   2018

  • 【IBDの病勢をいかに判断するか?】新しいバイオマーカーによる病勢評価の妥当性と問題点

    平岡 佐規子, 高嶋 志保, 井口 俊博, 半井 明日香, 高原 政宏, 加藤 順, 岡田 裕之

    IBD Research   11 ( 3 )   154 - 161   2017.9

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    炎症性腸疾患(IBD)のバイオマーカーとして、欧米で広く使われている便中カルプロテクチンが保険収載された。便中カルプロテクチンは腸管に浸潤した炎症細胞に由来し、潰瘍性大腸炎(UC)・クローン病(CD)の両疾患で内視鏡的活動性と相関を認め、治療効果判定・再燃予測に応用可能と考えられる。免疫学的便潜血検査(FIT)との比較では、UCの粘膜治癒の検出にはFITのほうがすぐれているが、CDにおける小腸病変との関連などはカルプロテクチンのほうがすぐれている。便中マーカーはある一時点の絶対値を重視するのではなく、患者の経過中にくり返し測定し、病勢の推移を推定する指標として使うべきである。(著者抄録)

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  • 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   2017.9

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  • 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   2017.9

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  • 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   2017.9

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  • 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   2017.8

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    58歳男。20年前に予防的大腸亜全摘出術を受け、その後近医で経過観察されていた。今回、腹痛・嘔吐が突然出現し、腸閉塞を疑われ、当院に紹介された。大腸内視鏡検査の所見は残存直腸に5mm以下の腺腫性ポリープが数個残存するのみであった。経口ダブルバルーン小腸内視鏡検査でトライツ靱帯付近に全周性の狭窄を伴う隆起性病変を認めた。隆起表面は正常粘膜に覆われ、一部に発赤調の病変を認めた。上皮性腫瘍を疑い同部位から生検を施行したところ、病理診断はadenocarcinoma(Group5)であった。家族性大腸腺腫症に合併した小腸癌と診断し、腹腔鏡下小腸部分切除+周囲リンパ節郭清術を施行した。術後29日目のCTで肺転移を認め、52日目からFOLFOX+BV療法を開始し、140日目に肺転移巣に対して経皮的ラジオ波焼灼療法を施行した。現在、化学療法を継続中で、Performance Statusは0のままで推移している。

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  • 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   2017.8

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    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。

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  • Two Electrosurgical Endo-Knives for Endoscopic Submucosal Dissection of Colorectal Superficial Neoplasms: A Prospective Randomised Study

    Yuusaku Sugihara, Keita Harada, Yoshiro Kawahara, Daisuke Takei, Shiho Takashima, Toshihiro Inokuchi, Asuka Nakarai, Masahiro Takahara, Kenji Kuwaki, Sakiko Hiraoka, Hiroyuki Okada

    GASTROINTESTINAL ENDOSCOPY   85 ( 5 )   AB389 - AB389   2017.5

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  • FECAL IMMUNOCHEMICAL TEST AND FECAL CALPROTECTIN SHOW DIFFERENT PROFILES IN DISEASE MONITORING FOR ULCERATIVE COLITIS

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

    GASTROENTEROLOGY   152 ( 5 )   S770 - S770   2017.4

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  • 【腸炎まるわかり】腸管Behcet病と単純性潰瘍

    平岡 佐規子, 井口 俊博, 川野 誠司, 原田 馨太, 岡田 裕之

    消化器内視鏡   29 ( 1 )   55 - 59   2017.1

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    腸管Behcet病および単純性潰瘍は、内視鏡像は酷似しているが、前者はBehcet徴候を有する全身性疾患で、後者は腸管に限局した疾患である。基本的には別の疾患と考えられるが、鑑別が難しい場合もある。両疾患の定型病変は回盲部の円形または類円形の深掘れ潰瘍である。その特徴的な形態から診断は容易なこともあるが、特に単純性潰瘍は他疾患との鑑別も必要である。(著者抄録)

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  • 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, 岡田裕之

    Gastroenterological Endoscopy (Web)   59 ( Supplement2 )   2017

  • 当院での潰瘍性大腸炎患者における上部消化管病変の検討

    加藤諒, 岩室雅也, 平岡佐規子, 高嶋志保, 半井明日香, 井口俊博, 岡田裕之

    Gastroenterological Endoscopy (Web)   59 ( Supplement2 )   2017

  • クローン病小腸狭窄病変に対するダブルバルーン小腸内視鏡逆行性造影の有用性の検討

    岡崎倫子, 井口俊博, 平岡佐規子, 竹井大介, 高嶋志保, 原田馨太, 川野誠司, 岡田裕之

    Gastroenterological Endoscopy (Web)   59 ( Supplement1 )   2017

  • 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 (Web)   59 ( Supplement1 )   2017

  • 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 (Web)   59 ( Supplement2 )   2017

  • 画像を診る 鑑別診断のポイント サイトメガロウイルス腸炎

    平岡 佐規子

    消化器の臨床   19 ( 6 )   476 - 478   2016.12

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  • Is the experience of stomach ESD necessary for colorectal ESD?

    Keita Harada, Daisuke Takei, Yuusaku Sugihara, Sakiko Hiraoka, Mitsuhiro Akita, Eisuke Kaji, Toshio Uraoka, Yoshiro Kawahara, Hiroyuki Okada

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   31   312 - 312   2016.11

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  • 臨床例 リンパ濾胞性直腸炎に類似した内視鏡像で発症した潰瘍性大腸炎の1例

    岩室 雅也, 宮部 欽生, 高田 尚良, 平岡 佐規子, 宇田 征史

    診断と治療   104 ( 10 )   1346 - 1349   2016.10

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  • Fecal Immunochemical Test Versus Fecal Calprotectin for Prediction of Mucosal Healing in Crohn's Disease

    Inflammatory bowel diseases : highlights from the official journal of the Crohn's & Colitis Foundation of America, Inc   7 ( 2 )   13 - 21   2016.9

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  • 症例 増大傾向を示し術前診断が困難であった虫垂子宮内膜症の1例

    加藤 諒, 杉原 雄策, 原田 馨太, 高嶋 志保, 竹井 大介, 井口 俊博, 半井 明日香, 高原 政宏, 平岡 佐規子, 田中 健大, 岡田 裕之

    消化器の臨床   19 ( 3 )   258 - 262   2016.6

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  • Metachronous Neoplasia and Local Recurrence After Colorectal ESD

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

    GASTROINTESTINAL ENDOSCOPY   83 ( 5 )   AB409 - AB409   2016.5

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  • Terminal Ileum Imaging With Colonoscopy Is Marker for Evaluation of Acute Graft-Versus-Host Disease Severity After Allogeneic Bone Marrow Transplantation

    Yuusaku Sugihara, Sakiko Hiraoka, Shiho Takashima, Daisuke Takei, Toshihiro Inokuchi, Asuka Nakarai, Masahiro Takahara, Kenji Kuwaki, Keita Harada, Nobuharu Fujii, Takehiro Tanaka, Hiroyuki Okada

    GASTROINTESTINAL ENDOSCOPY   83 ( 5 )   AB325 - AB325   2016.5

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  • Consecutive Measurements by Fecal Immunochemical Test in Quiescent Ulcerative Colitis Patients Can Detect Subclinical Relapse

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

    GASTROENTEROLOGY   150 ( 4 )   S213 - S213   2016.4

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  • Fecal Immunochemical Test Versus Fecal Calprotectin for the Predictive Ability of the Prognosis of Ulcerative Colitis

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

    GASTROENTEROLOGY   150 ( 4 )   S444 - S444   2016.4

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  • Fecal Immunochemical Test Versus Fecal Calprotectin for Prediction of Mucosal Healing in Crohn's Disease

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

    GASTROENTEROLOGY   150 ( 4 )   S991 - S991   2016.4

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  • 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   2016.3

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  • Overt on going OGIBに対する緊急小腸内視鏡施行例の検討

    川野誠司, 井口俊博, 河野吉泰, 三浦公, 神崎洋光, 喜多雅英, 原田馨太, 平岡佐規子, 河原祥朗, 岡田裕之

    日本消化管学会総会学術集会プログラム・抄録集   12th   2016

  • CD診療における免疫学的便潜血検査の使い方~便中カルプロテクチンとの対比から~

    井口俊博, 平岡佐規子, 加藤順

    日本消化器病学会雑誌   113   2016

  • クローン病小腸狭窄病変に対する小腸内視鏡下バルーン拡張術の有効性の検討

    井口俊博, 川野誠司, 平岡佐規子, 高嶋志保, 河野吉泰, 竹井大介, 半井明日香, 杉原雄策, 原田馨太, 岡田裕之, 岡田裕之

    日本消化管学会総会学術集会プログラム・抄録集   12th   2016

  • 潰瘍性大腸炎治療で粘膜治癒の達成には免疫学的便潜血持続陰性が指標になる

    井口俊博, 平岡佐規子, 岡田裕之

    日本消化器病学会大会(Web)   58th   2016

  • Terminal ileum imaging with colonoscopy to evaluate acute graft-versus-host disease severity after allogeneic bone marrow transplantation

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

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   30   172 - 172   2015.12

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  • 原発性小腸癌34例の治療成績

    秋元 悠, 那須 淳一郎, 岩室 雅也, 神崎 洋光, 堤 康一郎, 喜多 雅英, 川野 誠司, 原田 馨太, 加藤 博也, 平岡 佐規子, 河原 祥朗, 八木 孝仁, 大塚 文男, 岡田 裕之

    日本病院総合診療医学会雑誌   9 ( 1 )   23 - 29   2015.10

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    当院の原発性小腸癌患者34例の治療成績を解析した。原発部位は十二指腸29例、空腸3例、回腸1例、空腸または回腸1例、臨床病期はStage I 11例、Stage II 5例、Stage III 6例、Stage IV 12例。治療内容は、Stage Iでは内視鏡的切除5例と手術6例、Stage II/Stage IIIでは全例手術、Stage IVでは化学療法のみが3例、化学療法+原発巣切除が3例、原発巣切除+転移巣切除が4例、緩和治療が2例で、5年生存率はStage I/IIが80%、Stage IIIが33%、Stage IVが39%であった。(著者抄録)

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    Other Link: http://search.jamas.or.jp/link/ui/2016257946

  • 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   2015.9

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  • Evaluation of Mucosal Healing in Ulcerative Colitis by Fecal Calprotectin Versus Fecal Immunochemical Test

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

    GASTROENTEROLOGY   148 ( 4 )   S207 - S207   2015.4

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  • Tacrolimus Therapy for Outpatients With Refractory Ulcerative Colitis

    Sakiko Hiraoka, Toshihiro Inokuchi, Daisuke Takei, Asuka Nakarai, Yuusaku Sugihara, Yuki Morito, Sakuma Takahashi, Keita Harada, Hiroyuki Okada, Kazuhide Yamamoto, Jun Kato

    GASTROENTEROLOGY   148 ( 4 )   S870 - S871   2015.4

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  • Fecal Immunochemical Test Versus Fecal Calprotectin for Prediction of Mucosal Healing in Crohn's Disease

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

    GASTROENTEROLOGY   148 ( 4 )   S451 - S451   2015.4

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  • Ulcerative Colitis Patients in Clinical Remission Demonstrate Correlations Between Fecal Immunochemical Test Results, Mucosal Healing, and Risk of Relapse

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

    GASTROENTEROLOGY   148 ( 4 )   S194 - S194   2015.4

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  • 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   2015.4

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  • 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   2015.4

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  • 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   2015.3

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  • 潰瘍性大腸炎に合併した腎血管性高血圧の1例

    田中 景子, 内田 治仁, 平松 澄恵, 天田 雅文, 井上 章子, 奥山 由加, 梅林 亮子, 郷原 英夫, 大澤 晋, 平岡 佐規子, 寺坂 律子, 杉山 斉, 和田 淳

    脈管学   54 ( 10 )   167 - 172   2014.10

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    腎血管性高血圧はさまざまな疾患を原因とする。今回我々は、潰瘍性大腸炎に腎血管性高血圧を合併した症例を経験した。症例は40歳男性。造影CTと血管造影で右腎動脈の閉塞と側副血行路の発達を認めた。さらに左腎区域動脈と肝動脈の狭小化、両側内腸骨動脈の閉塞と腹部大動脈の一部壁不整がみられた。FDG-PETで大動脈炎症候群は否定的であった。皮疹や結腸粘膜の生検で血管炎の所見は得られず、診断に苦慮した症例であった。(著者抄録)

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  • CD長期罹患例を検討し、抗TNFα抗体治療の不要なCD症例を探る

    井口 俊博, 平岡 佐規子, 加藤 順, 竹井 大介, 半井 明日香, 原田 馨太, 岡田 裕之, 山本 和秀

    日本消化器病学会雑誌   111 ( 臨増大会 )   A881 - A881   2014.9

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  • Colitic cancerおよびhigh grade dysplasiaを合併した潰瘍性大腸炎の臨床病理学的特徴

    稲田 涼, 近藤 喜太, 母里 淑子, 岸本 浩行, 永坂 岳司, 平岡 佐規子, 藤原 俊義

    日本消化器病学会雑誌   111 ( 臨増大会 )   A889 - A889   2014.9

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  • 炎症性腸疾患における内科・外科の接点 腸管切除後のCD患者が再手術となるリスク因子の検討 適切な術後治療へ向けて

    井口 俊博, 平岡 佐規子, 岡田 裕之

    日本消化器病学会雑誌   111 ( 臨増大会 )   A536 - A536   2014.9

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  • Colitic cancerおよびhigh grade dysplasiaを合併した潰瘍性大腸炎の臨床病理学的検討

    稲田 涼, 近藤 喜太, 母里 淑子, 岸本 浩行, 永坂 岳司, 平岡 佐規子, 藤原 俊義

    日本癌治療学会誌   49 ( 3 )   904 - 904   2014.6

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  • 当院における消化管神経内分泌腫瘍(NET)の治療成績

    筑木 隆雄, 岡田 裕之, 山本 和秀, 河原 祥朗, 那須 淳一郎, 平岡 佐規子, 原田 馨太, 松原 稔, 喜多 雅英, 堀 圭介, 秋田 光洋, 高橋 索真, 神崎 洋光, 井口 俊博, 三浦 公, 河野 吉泰, 半井 明日香, 森藤 由記, 竹井 大介

    Gastroenterological Endoscopy   56 ( Suppl.1 )   1339 - 1339   2014.4

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  • 当院におけるパテンシーカプセルの使用経験

    森藤 由記, 川野 誠司, 平岡 佐規子, 井口 俊博, 竹井 大介, 半井 明日香, 高橋 索真, 秋田 光洋, 原田 馨太, 岡田 裕之, 山本 和秀

    Gastroenterological Endoscopy   56 ( Suppl.1 )   1167 - 1167   2014.4

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  • IBDにおける粘膜治癒の判定基準とその臨床的意義 潰瘍性大腸炎の予後はMayo Endoscopic subscore(MES)0とMES1で異なり、両者は血小板数で鑑別可能である

    半井 明日香, 井口 俊博, 平岡 佐規子

    Gastroenterological Endoscopy   56 ( Suppl.1 )   866 - 866   2014.4

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  • Ras/ERK系と大腸粘膜治癒 Ras/ERK系の阻害因子Spred-2の解析を通じて

    高橋 索真, 平岡 佐規子, 伏見 聡一郎, 伊藤 利洋, 板倉 淳哉, 木村 亮二朗, 楊 旭, 篠倉 美理, 中川 裕貴, 住居 優一, 竹井 大介, 井口 俊博, 半井 明日香, 森藤 由記, 秋田 光洋, 原田 馨太, 岡田 裕之, 松川 昭博, 山本 和秀

    消化器と免疫   ( 50 )   66 - 68   2014.3

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    【目的】Ras/ERK系を抑制するSpred-2のIBDへの関与を検討する。【方法】Spred-2 KOマウスおよびWTマウスにDSS腸炎を誘導し、症状変化・組織像・大腸粘膜の細胞増殖を評価した。【結果】Spred-2 KOマウスではWTマウスより腸炎の症状が軽く、腸管上皮の再生が速やかであった。また、腸管上皮中のBrdU陽性細胞の比率が有意に高かった。【結論】Spred-2はIBDにおける粘膜治癒を抑制している可能性がある。(著者抄録)

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  • 【IBD診療に有用なインデックスはこれだ!】便検査は内視鏡検査の代わりになりうるか?

    平岡 佐規子, 半井 明日香, 加藤 順

    IBD Research   8 ( 1 )   22 - 29   2014.3

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    炎症性腸疾患(IBD)の治療目標の一つとして、粘膜治癒があげられる。粘膜治癒の評価には内視鏡検査が必要であるが、内視鏡的活動性を評価できる代替マーカーとして、便中マーカーが注目されている。報告が多いのは、便中カルプロテクチン、便中ラクトフェリンであるが、それ以外に、潰瘍性大腸炎(UC)に関しては、大腸がん検診で長く使用されている免疫学的便潜血検査も有用である。(著者抄録)

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  • 【小腸粘膜傷害の診断と治療の最前線】小腸粘膜傷害の診断に対する小腸内視鏡の有用性と限界

    川野 誠司, 岡田 裕之, 井口 俊博, 秋田 光洋, 喜多 雅英, 原田 馨太, 平岡 佐規子, 那須 淳一郎, 河原 祥朗, 山本 和秀

    消化管の臨床   19   17 - 21   2014.3

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    小腸粘膜傷害を認めた非腫瘍性疾患のうち、慢性疾患を中心に内視鏡像から(1)縦走潰瘍、(2)小病変(びらん、アフタ)、(3)輪状潰瘍に分類し、小腸内視鏡の有用性と限界について検討した。クローン病とNSAIDs起因性小腸粘膜傷害は、(1)〜(3)すべての像を呈する場合があり、常に鑑別診断として念頭に置いておく必要がある。一方で、輪状潰瘍を呈する疾患では確定診断不能な症例を経験した。今後、このような症例を重ねて検討を追加していくと同時に、各疾患の病態や治療についてもさらなる検討を必要とすると考えられた。(著者抄録)

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  • 当院における原発性小腸癌34例の検討

    秋元 悠, 那須 淳一郎, 神崎 洋光, 堤 康一郎, 松原 稔, 筑木 隆雄, 喜多 雅英, 川野 誠司, 原田 馨太, 加藤 博也, 平岡 佐規子, 河原 祥朗, 岡田 裕之, 八木 孝仁, 山本 和秀

    日本消化器病学会雑誌   111 ( 臨増総会 )   A347 - A347   2014.3

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  • 免疫学的便潜血定量法による潰瘍性大腸炎の粘膜治癒評価

    半井 明日香, 加藤 順, 平岡 佐規子, 栗山 宗彰, 井口 俊博, 竹井 大介, 森藤 由記, 秋田 光洋, 高橋 索真, 原田 馨太, 岡田 裕之, 山本 和秀

    岡山医学会雑誌   125 ( 3 )   221 - 223   2013.12

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    大腸内視鏡検査と免疫学的便潜血定量法(FIT)をほぼ同時に行った潰瘍性大腸炎(UC)患者152人(男性77人、女性75人、年齢中央値31歳)を対象に、便中ヘモグロビン(Hb)濃度と内視鏡所見を比較し、FITによる粘膜治癒評価の有用性について検討した。病型は全大腸炎型98、左側結腸炎型31、直腸炎型23であった。便中Hb濃度と大腸粘膜所見のMayo endoscopic scoreとの間に有意な相関を認め(Spearman順位相関係数=0.549)、FIT陰性例(Hb濃度<100ng/ml)はscore 0で92%、score 1で47%、score 2で13%、score 3で12%を占め、scoreが小さいほど陰性例の割合が有意に多かった。FIT陰性例の粘膜治癒予測能はscore 0で感度0.92、特異度0.71、正診率0.74、score 0、1で各々0.60、0.87、0.72であり、FIT陽性例(Hb濃度≧100ng/ml)ではscore 2、3で各々0.87、0.60、0.72であった。FITはUCにおける粘膜状態を良く反映し、特にFIT陰性は粘膜治癒と強く相関した。

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  • Predictive Factors for Mucosal Healing in Crohn's Disease Patients With Unelevated Serum CRP Levels

    Asuka Nakarai, Sakiko Hiraoka, Jun Kato, Toshihiro Inokuchi, Mitsuhiro Akita, Tomoko Hirakawa, Keisuke Hori, Keita Harada, Hiroyuki Okada, Kazuhide Yamamoto

    GASTROENTEROLOGY   144 ( 5 )   S776 - S776   2013.5

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  • Long-Term Follow-up of Ulcerative Colitis Patients Treated by the Strategy Based on Cytomegalovirus Antigen Status

    Toshihiro Inokuchi, Jun Kato, Sakiko Hiraoka, Hideyuki Suzuki, Tomoko Hirakawa, Mitsuhiro Akita, Sakuma Takahashi, Keita Harada, Hiroyuki Okada, Kazuhide Yamamoto

    GASTROENTEROLOGY   144 ( 5 )   S229 - S229   2013.5

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  • Prediction of Dose of Tacrolimus Required for Remission Induction of Ulcerative Colitis Patients

    Sakiko Hiraoka, Jun Kato, Toshihiro Inokuchi, Asuka Nakarai, Tomoko Hirakawa, Mitsuhiro Akita, Keita Harada, Hiroyuki Okada, Kazuhide Yamamoto

    GASTROENTEROLOGY   144 ( 5 )   S407 - S407   2013.5

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  • CRPの上昇がみられないクローン病患者における粘膜治癒の指標

    半井 明日香, 平岡 佐規子, 加藤 順, 井口 俊博, 平川 智子, 高橋 索真, 秋田 光洋, 堀 圭介, 原田 馨太, 岡田 裕之, 山本 和秀

    Gastroenterological Endoscopy   55 ( Suppl.1 )   1043 - 1043   2013.4

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  • 内視鏡検査にて診断された小腸原発悪性リンパ腫の検討

    川野 誠司, 岡田 裕之, 井口 俊博, 秋田 光洋, 喜多 雅英, 原田 馨太, 平岡 佐規子, 那須 淳一郎, 河原 祥朗, 吉野 正, 山本 和秀

    日本消化器病学会雑誌   110 ( 臨増総会 )   A263 - A263   2013.2

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  • 大腸ESDにおける穿孔例の検討

    原田 馨太, 平岡 佐規子, 岡田 裕之, 井口 俊博, 半井 明日香, 平川 智子, 秋田 光洋, 喜多 雅英, 松原 稔, 川野 誠司, 那須 淳一郎, 河原 祥朗, 山本 和秀

    日本消化器病学会雑誌   110 ( 臨増総会 )   A290 - A290   2013.2

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  • Ras/Raf/ERKの抑制因子Spred-2は、マウス炎症性腸疾患モデルにおいて、腸管再生抑制に関与している

    高橋 索真, 平岡 佐規子, 井口 俊博, 半井 明日香, 平川 智子, 秋田 光洋, 原田 馨太, 岡田 裕之, 山本 和秀

    日本消化器病学会雑誌   110 ( 臨増総会 )   A224 - A224   2013.2

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  • サイトメガロウイルス抗原陽性及び陰性UC症例の内科的治療法と長期手術率

    井口 俊博, 平岡 佐規子, 加藤 順, 半井 明日香, 鈴木 英之, 秋田 光洋, 高橋 索真, 原田 馨太, 岡田 裕之, 山本 和秀

    日本消化器病学会雑誌   110 ( 臨増総会 )   A202 - A202   2013.2

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  • Readministration of Calcineurin Inhibitors for Ulcerative Colitis (vol 46, pg 1315, 2012)

    Sakiko Hiraoka

    ANNALS OF PHARMACOTHERAPY   46 ( 11 )   1578 - 1578   2012.11

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    DOI: 10.1345/aph.1R210a

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  • 比較的大型の大腸腫瘍に対するEMRの有用性について

    原田 馨太, 平岡 佐規子, 高橋 索真, 平川 智子, 秋田 光洋, 加地 英輔, 那須 淳一郎, 河原 祥朗, 岡田 裕之, 山本 和秀

    Gastroenterological Endoscopy   54 ( Suppl.2 )   2921 - 2921   2012.9

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  • 難治性潰瘍性大腸炎におけるインフリキシマブ治療効果と前治療の有効性との関係

    平川 智子, 平岡 佐規子, 高橋 索真, 秋田 光洋, 原田 馨太, 加藤 順, 岡田 裕之, 山本 和秀

    日本消化器病学会雑誌   109 ( 臨増大会 )   A834 - A834   2012.9

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  • 他臓器癌の併存または既往は大腸腫瘍のリスクとなるか?(Is Presence or History of Extracolonic Primary Malignancy a Risk for Colorectal Neoplasia?)

    秋田 光洋, 平岡 佐規子, 平川 智子, 原田 馨太, 山本 和秀, 加藤 順

    日本癌学会総会記事   71回   172 - 173   2012.8

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  • タクロリムスにより寛解導入を行った潰瘍性大腸炎の小児例

    藤井 洋輔, 小寺 亜矢, 長岡 義晴, 八代 将登, 山下 信子, 塚原 宏一, 森島 恒雄, 平岡 佐規子, 加藤 順

    小児科臨床   65 ( 6 )   1183 - 1188   2012.6

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    症例は14歳女児。発熱、腹痛、下痢で発症し、入院後の大腸内視鏡検査で潰瘍性大腸炎(ulcerative colitis:以下UC)と診断された。全大腸炎型UCであり、臨床的重症度分類では中等症であった。プレドニゾロン、5-アミノサリチル酸製剤により寛解導入を試みたが、治療中に重症化したため、経口タクロリムス療法を併用した。治療開始5日目ころから血便、腹痛が改善し、寛解に導入できた。タクロリムス使用中重大な副作用は認められなかった。また、経過中に酸化ストレスの指標である血清総ハイドロペルオキシド濃度を計測した。その値は病勢に一致して変動しており、UCの病態生理に酸化ストレス亢進が関与することが示唆された。タクロリムスは近年内科領域で難治性のUCに対し使用され、効果をあげている。今後、小児のUCに対する有効な治療選択の1つとして期待される。(著者抄録)

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  • Readministration of Calcineurin Inhibitors is Not Effective for Ulcerative Colitis Patients Who Relapsed After Remission by Treatment With Calcineurin Inhibitors

    Sakiko Hiraoka, Jun Kato, Hideyuki Suzuki, Tomoko Hirakawa, Mitsuhiro Akita, Shunsuke Saito, Eisuke Kaji, Kazuhide Yamamoto

    GASTROENTEROLOGY   142 ( 5 )   S799 - S799   2012.5

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  • Disparity in Clinical Care for Patients With Inflammatory Bowel Disease Between Specialists and Non-Specialists

    Tomoko Hirakawa, Jun Kato, Sakuma Takahashi, Hideyuki Suzuki, Mitsuhiro Akita, Shunsuke Saito, Eisuke Kaji, Sakiko Hiraoka, Hiroyuki Okada, Kazuhide Yamamoto

    GASTROENTEROLOGY   142 ( 5 )   S779 - S779   2012.5

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  • Evaluation of Mucosal Healing of Ulcerative Colitis by Using a Quantitative Fecal Immunochemical Test

    Asuka Nakarai, Sakiko Hiraoka, Jun Kato, Motoaki Kuriyama, Mitsuhiro Akita, Tomoko Hirakawa, Shunsuke Saito, Eisuke Kaji, Hiroyuki Okada, Kazuhide Yamamoto

    GASTROENTEROLOGY   142 ( 5 )   S655 - S656   2012.5

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  • 大腸鋸歯状病変に合併した早期大腸癌の3例

    半井 明日香, 平岡 佐規子, 平川 智子, 秋田 光洋, 斉藤 俊介, 加地 英輔, 岡田 裕之, 山本 和秀, 永坂 岳司, 田中 健大

    日本消化器病学会雑誌   109 ( 臨増総会 )   A319 - A319   2012.3

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  • Which Colorectal Serrated Lesion Could Develop Into Microsatellite Instability Cancer: Genetic, Epigenetic and Endoscopic Analyses

    Eisuke Kaji, Toshio Uraoka, Jun Kato, Sakiko Hiraoka, Hideyuki Suzuki, Mitsuhiro Akita, Shunsuke Saito, Reiji Higashi, Kazuhide Yamamoto

    GASTROENTEROLOGY   140 ( 5 )   S352 - S352   2011.5

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  • Detectability of Colorectal Neoplasia With Fluorine-18-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT)

    Tomoko Hirakawa, Jun Kato, Yoshihiro Okumura, Keisuke Hori, Sakuma Takahashi, Hideyuki Suzuki, Mitsuhiro Akita, Reiji Higashi, Shunsuke Saito, Eisuke Kaji, Toshio Uraoka, Sakiko Hiraoka, Kazuhide Yamamoto

    GASTROENTEROLOGY   140 ( 5 )   S415 - S415   2011.5

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  • Do Smoking and Drinking Habits and Obesity Affect Prevalence of Colorectal Neoplasia in Patients With Positive Immunochemical Fecal Occult Blood Test?

    Sakiko Hiraoka, Jun Kato, Motoaki Kuriyama, Mitsuhiro Akita, Hideyuki Suzuki, Tomoko Hirakawa, Shunsuke Saito, Eisuke Kaji, Hiroyuki Okada, Kazuhide Yamamoto

    GASTROENTEROLOGY   140 ( 5 )   S290 - S290   2011.5

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  • 【消化管癌の自然史】大腸腫瘍の自然史におけるRasシグナル異常 腫瘍局在による異常パターンの違いについて

    原田 馨太, 平岡 佐規子, 加藤 順, 山本 和秀

    消化器科   49 ( 2 )   166 - 172   2009.8

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    大腸腫瘍の自然史におけるRasシグナル異常について検討した。対象は大腸ポリープ切除を受けた97人(年齢中央値67歳)からの120検体であった。1)腫瘍存在部位は近位結腸48(40%)、遠位結腸49(41%)、直腸23(19%)で、病理では管状腺腫72(60%)、管状絨毛腺腫40(33)、鋸歯状腺腫8(7%)であった。2)49検体(41%)にK-ras/BRAF変異が認められ、近位結腸・直腸で多く、遠位結腸で少ない傾向であった。3)30検体(25%)にRASSF2のメチル化がみられ、近位結腸・直腸で多く、遠位結腸で少ない傾向であった。4)RASSF2メチル化を有する腺腫の73%にK-ras/BRAF変異を有しており、多変量解析では鋸歯状腺腫が有意に関連し(OR 11.11)、遠位結腸で有意に関連が少なかった(OR 0.13)。5)大腸癌切除標本からの65検体ではK-ras/BRAF変異とRASSF2メチル化の両方を認めたのは近位結腸・直腸で多く、遠位結腸で少なかったが、癌では腺腫に比べ近位結腸での頻度が有意に高かった。

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  • 腎不全患者における葉酸・ホモシステインの大腸腫瘍発生に与える影響(Effect of Mate and homocysteine on colon tumorgenesis in end-stage renal disease patients)

    加地 英輔, 加藤 順, 齊藤 俊介, 堀井 城一朗, 原田 馨太, 平岡 佐規子, 山本 和秀

    日本癌学会総会記事   68回   306 - 306   2009.8

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  • Effect of Folate and Homocysteine On Colon Tumorigenesis: An Analysis of Colonoscopic Findings and Serum Folate and Homocysteine Status in Renal Failure Patients

    Eisuke Kaji, Jun Kato, Joichiro Horii, Shunsuke Saito, Keita Harada, Sakiko Hiraoka, Kazuhide Yamamoto

    GASTROENTEROLOGY   136 ( 5 )   A765 - A765   2009.5

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  • Tolerability and Usefulness of Mercaptopurine in Azathioprine-Intolerant Japanese Patients with Ulcerative Colitis

    Motoaki Kuriyama, Jun Kato, Sakiko Hiraoka, Hiroyuki Okada, Kazuhide Yamamoto

    GASTROENTEROLOGY   136 ( 5 )   A657 - A657   2009.5

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  • Specific Endoscopic Features of Ulcerative Colitis Complicated with Cytomegalovirus Infection

    Hideyuki Suzuki, Jun Kato, Motoaki Kuriyama, Sakiko Hiraoka, Kenji Kuwaki, Kazuhide Yamamoto

    GASTROENTEROLOGY   136 ( 5 )   A352 - A352   2009.5

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  • Prediction of Flare-Ups of Ulcerative Colitis Using Quantitative Immunochemical Fecal Occult Blood Test

    Motoaki Kuriyama, Jun Kato, Koji Takemoto, Sakiko Hiraoka, Hiroyuki Okada, Kazuhide Yamamoto

    GASTROENTEROLOGY   136 ( 5 )   A667 - A667   2009.5

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  • Are Patients with Intraductal Papillary Mucinous Neoplasm (IPMN) of Pancreas Likely to Carry Colorectal Neoplasia?

    Shin Ishikawa, Jun Kato, Hideyuki Suzuki, Joichiro Horii, Shunsuke Saito, Reiji Higashi, Ken Hirao, Hironari Kato, Motoaki Kuriyama, Eisuke Kaji, Toshio Uraoka, Sakiko Hiraoka, Kazuhide Yamamoto

    GASTROINTESTINAL ENDOSCOPY   69 ( 5 )   AB289 - AB290   2009.4

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  • Carbon Dioxide Insufflation for Potentially Difficult Colonoscopies Performed Without Sedation: Valuable Training for Inexperienced Colonoscopists

    Toshio Uraoka, Jun Kato, Motoaki Kuriyama, Keisuke Hori, Shin Ishikawa, Keita Harada, Koji Takemoto, Sakiko Hiraoka, Joichiro Horii, Hideyuki Fujita, Hideyuki Suzuki, Kazuhide Yamamoto

    GASTROINTESTINAL ENDOSCOPY   69 ( 5 )   AB215 - AB215   2009.4

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  • 大腸内視鏡検査のトレーニングシステムには、CO2送気の導入が望まれる

    浦岡 俊夫, 加藤 順, 栗山 宗彰, 原田 馨太, 石川 信, 竹本 浩二, 平岡 佐規子, 堀井 城一朗, 藤田 英行, 鈴木 英之, 堀 圭介, 山本 和秀

    日本消化器病学会雑誌   106 ( 臨増総会 )   A255 - A255   2009.3

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  • 腹腔鏡補助下手術を施行した大腸内視鏡検査で発見された回腸カルチノイド腫瘍の一例

    小林 直哉, 香川 俊輔, 近藤 喜太, 楳田 祐三, 西谷 正史, 山辻 知樹, 白川 靖博, 田辺 俊介, 藤原 康宏, 宇野 太, 猶本 良夫, 田中 紀章, 堀井 城一朗, 川野 誠司, 浦岡 俊夫, 平岡 佐規子, 加藤 順, 岡田 裕之, 山本 和秀, 大原 信哉, 市村 浩一, 大森 昌子, 森谷 行利

    外科治療   100 ( 2 )   212 - 215   2009.2

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    症例は61歳男性で検診にて便潜血反応を指摘され、精検の大腸内視鏡では大腸に特記すべき所見は認めなかったが、回腸終末部(バウヒン弁から3cm口側)に10mm大の粘膜下腫瘍様突起を認め、生検所見から回腸カルチノイド腫瘍と診断された。入院時、血液・生化学試験は正常範囲で、腹部CTでは造影にて回腸末端部位に造影効果を有する10mm大の腫瘍像を認め、小腸内視鏡では多発病変は認めなかった。治療は腹腔鏡補助下に第2群リンパ節郭清D2+回盲部切除術を施行、切除標本は10×10mm大で漿膜への露出は認めず、術後経過良好で10日目に退院となった。病理組織学的所見では腫瘍は粘膜下層を主座に増生し、表層は一部粘膜内、深部は固有筋層から一部漿膜下層への浸潤を認め、深達度SSで第1群リンパ節転移陽性、脈管侵襲陽性(ly1・v1)であった。主体は異型を伴うカルチノイド腫瘍像で、最近の分類では高分化神経内分泌癌(well differentiated neuroendocrine carcinoma、G2、T3、N1、Stage IIIBに相当した。

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  • 切除18ヵ月後に肝転移をきたした径7mmのS状結腸早期癌の1例

    原田馨太, 加藤順, 竹本浩二, 浦岡俊夫, 平岡佐規子, 柳井広之, 山本和秀

    日本消化器病学会雑誌   106 ( 5 )   660 - 667   2009

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    症例は74歳男性。便潜血陽性に対する精査目的の大腸内視鏡検査にて、S状結腸に径7mm大のO-Is型腫瘍を指摘され、内視鏡的粘膜切除術を施行した。切除標本の病理組織学的診断は高分化腺癌で、粘膜下浸潤と脈管侵襲が認められたため、追加切除を行った。しかし術後18ヵ月目にCEAの上昇を認め、腹部造影CT、FDG-PET、超音波エコー検査にて15mmの単発肝転移による異時性再発を診断された。(著者抄録)

    DOI: 10.11405/nisshoshi.106.660

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  • 大腸正常粘膜におけるDNAメチル化と大腸腫瘍発生の関連 (消化管疾患に対する新しいアプローチ) -- (消化器病におけるエピジェネティック異常)

    平岡 佐規子, 加藤 順, 堀井 城一朗

    消化器医学   7   81 - 85   2009

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  • 左側結腸において正常粘膜のDNAメチル化と大腸腫瘍発生・進展とは関連する(Methylation of background normal mucosa is correlated with occurrence and development of neoplasia in the distal colon)

    平岡 佐規子, 加藤 順, 堀井 城一朗, 斉藤 俊介, 加地 英輔, 原田 馨太, 藤田 英行, 山本 和秀

    日本癌学会総会記事   67回   208 - 208   2008.9

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  • 大腸ポリープにおけるK-rasのG to A変異はMGMTのメチル化よりもESR1のメチル化と関連する(K-ras G to A transition in colorectal adenomas is not correlated with methylation of MGMT, but with that of ESR1)

    堀井 城一朗, 平岡 佐規子, 加藤 順, 斉藤 俊介, 加地 英輔, 原田 馨太, 藤田 英行, 山本 和秀

    日本癌学会総会記事   67回   171 - 171   2008.9

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  • Methylation status of background normal mucosa is correlated with occurrence and development of neoplasia in the distal colon

    Sakiko Hiraoka, Joichiro Horii, Jun Kato, Shunsuke Saito, Keita Harada, Hideyuki Fujita, Motoaki Kuriyama, Koji Takemoto, Toshio Uraoka, Kazuhide Yamamoto

    GASTROENTEROLOGY   134 ( 4 )   A616 - A616   2008.4

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  • 低用量アスピリン内服患者における便潜血検査の意義

    石川 信, 加藤 順, 山本 和秀, 浦岡 俊夫, 平岡 佐規子, 竹本 浩二, 栗山 宗彰, 藤田 英行, 原田 馨太, 堀井 城一朗, 秋田 光洋, 斉藤 俊介, 鈴木 英之

    日本消化器病学会雑誌   105 ( 臨増総会 )   A197 - A197   2008.3

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  • 消化管癌の自然史を見直す 大腸腫瘍の自然史におけるRasシグナル異常 腫瘍局在による異常パターンの違いについて

    原田 馨太, 平岡 佐規子, 山本 和秀

    日本消化器病学会雑誌   105 ( 臨増総会 )   A142 - A142   2008.3

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  • K-ras/BRAF変異及びRASSF2メチル化を保持する大腸腺腫の特徴(Characteristics of colorectal adenomas carrying K-ras/BRAF mutation and RASSF2 methylation)

    原田 馨太, 平岡 佐規子, 加藤 順, 堀井 城一朗, 藤田 英行, 坂口 孝作

    日本癌学会総会記事   66回   84 - 84   2007.8

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  • 結腸癌細胞においてhMLH1の発現減少は5-フルオロウラシル介在性アポトーシスの減少に関連する(Decreased expression of hMLH1 correlates with reduced 5-fluorouracil-mediated apoptosis in colon cancer cells)

    藤田 英行, 加藤 順, 堀井 城一朗, 原田 馨太, 平岡 佐規子, 白羽 英則, 坂口 孝作, 白鳥 康史

    日本癌学会総会記事   66回   488 - 488   2007.8

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  • 正常結腸粘膜の広範的及び局所的なメチル化状態と進行性大腸癌のリスク(Global and locus specific methylation status of normal colon mucosa and risk of advanced colorectal neoplasia)

    平岡 佐規子, 加藤 順, 堀井 城一朗, 原田 馨太, 藤田 英行, 坂口 孝作, 白鳥 康史

    日本癌学会総会記事   66回   551 - 551   2007.8

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  • 大腸ポリープにおけるESR1のメチル化とK-ras mutationの関連(Methylation of estrogen receptor 1 in colorectal adenomas is not age-dependent but correlated with K-ras mutation)

    堀井 城一朗, 平岡 佐規子, 加藤 順, 原田 馨太, 藤田 英行, 坂口 孝作

    日本癌学会総会記事   66回   319 - 319   2007.8

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  • Clinical impact of endoscopic submucosal dissection (ESD) of large laterally spreading tumors (LSTS) in the colorectum

    Toshio Uraoka, Jun Kato, Yoshiro Kawahara, Takao Tsuzuki, Shin Ishikawa, Keita Harada, Motoaki Kuniyama, Sakiko Hiraoka, Hiroyuki Okada, Yutaka Saito

    GASTROINTESTINAL ENDOSCOPY   65 ( 5 )   AB255 - AB255   2007.4

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  • Age-related methylation of normal colon mucosa, and risk of colorectal neoplasia; The difference between proximal and distal colon

    Joichiro Horii, Sakiko Hiraoka, Jun Kato, Keita Harada, Hideyuki Fujita, Yasushi Shiratori

    GASTROENTEROLOGY   132 ( 4 )   A321 - A321   2007.4

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  • Uneven locational distribution of colorectal adenomas carrying K-RAS/Braf mutation and Rassf2 methylation

    Keita Harada, Jun Kato, Sakiko Hiraoka, Joichiro Horii, Hideyuki Fujuta, Yasushi Shiratori

    GASTROENTEROLOGY   132 ( 4 )   A320 - A320   2007.4

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  • Decreased expression of Hmlh1 correlates with reduced 5-fluorouracil-mediated apoptosis in colon cancer cells

    Hideyuki Fujita, Jun Kato, Joichiro Horii, Keita Harada, Sakiko Hiraoka, Hidenori Shiraha, Yasushi Shiratori

    GASTROENTEROLOGY   132 ( 4 )   A629 - A629   2007.4

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  • 大腸正常粘膜における加齢関連領域のメチル化と大腸発癌危険因子との関連

    堀井 城一朗, 平岡 佐規子, 加藤 順, 原田 馨太, 藤田 英行, 桑木 健志, 白鳥 康史

    日本消化器病学会雑誌   103 ( 臨増大会 )   A880 - A880   2006.9

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  • Risk factors and indications for first surgery in Crohn's disease patients: Analysis of 289 Japanese cases

    Naofumi Morimoto, Jun Kato, Motoaki Kuriyama, Toru Nawa, Manabu Kurome, Koji Takemoto, Sakiko Hiraoka, Yasushi Shiratori

    GASTROENTEROLOGY   130 ( 4 )   A621 - A621   2006.4

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  • Laterally spreading type of colorectal adenoma exhibits a unique methylation phenotype and K-ras mutations

    Sakiko Hiraoka, Jun Kato, Joichiro Horii, Keita Harada, Hideyuki Fujita, Tamiya Morikawa, Hidenori Shiraha, Yasushi Shiratori

    GASTROENTEROLOGY   130 ( 4 )   A716 - A716   2006.4

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  • 大腸腺腫におけるCpG islandのメチル化はその肉眼形態と発生部位により異なる

    平岡 佐規子, 加藤 順, 原田 馨太, 藤田 英行, 森本 尚史, 栗山 宗彰, 竹本 浩二, 黒目 学, 森川 民也, 河本 博文, 岡田 裕之, 白鳥 康史

    日本消化器病学会雑誌   102 ( 臨増総会 )   A241 - A241   2005.3

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  • 【年齢・性差と肝胆膵疾患】 年齢・性差と各種肝疾患 C型肝障害

    平岡佐規子, 高木章乃夫, 白鳥康史

    肝・胆・膵   51,2,199-204   2005

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  • Centrifugal Leukocytapheresis therapy without concurrent corticosteroid administartion for ulcerative colitis

    H Okada, J Kato, SI Hori, R Takenaka, S Hiraoka, A Fujiwara, C Makidono, H Kawamoto, M Mizuno, Y Shiratori

    GASTROENTEROLOGY   126 ( 4 )   A632 - A632   2004.4

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  • Heat shock protein 60 of Helicobacter pylori induces inflammatory responses through the toll-like receptor-triggered pathway in cultured human gastric epithelial cells

    R Takenaka, K Yokota, M Mizuno, Y Fujinami, T Toyokawa, S Hiraoka, S Hori, C Makidono, S Take, H Okada, K Oguma, Y Shiratori

    GASTROENTEROLOGY   124 ( 4 )   A590 - A590   2003.4

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  • Decay-accelerating factor as a surface marker for specialized columnar epithelium in Barrett's esophagus

    S Hiraoka, M Mizuno, R Terada, H Okazaki, S Hori, C Makidono, T Toyokawa, R Takenaka, S Take, K Yamamoto, H Okada, Y Shiratori

    GASTROENTEROLOGY   124 ( 4 )   A296 - A296   2003.4

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  • Advances in the development of a reliable assay for the measurement of stool decay-accelerating factor in the detection of colorectal cancer

    M Mizuno, J Nasu, M Mizuno, N Iwagaki, H Okazaki, S Hori, S Hiraoka, C Makidono, H Okada, T Tsuji, Y Shiratori, T Fujita

    GASTROENTEROLOGY   122 ( 4 )   A479 - A479   2002.4

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Awards

  • 天晴ジョイボスアワード

    2020.12   岡山県医師会  

Research Projects

  • Construction of a home fecal immunochemical test for self-management in patients with ulcerative colitis

    Grant number:23K11871  2023.04 - 2027.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

    平岡 佐規子, 高原 政宏, 井口 俊博

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    Grant amount:\3250000 ( Direct expense: \2500000 、 Indirect expense:\750000 )

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  • 潰瘍性大腸炎患者における免疫学的便潜血検査自宅測定の有用性の検討

    Grant number:20K12669  2020.04 - 2023.03

    日本学術振興会  科学研究費助成事業 基盤研究(C)  基盤研究(C)

    平岡 佐規子, 高原 政宏

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    Grant amount:\3900000 ( Direct expense: \3000000 、 Indirect expense:\900000 )

    潰瘍性大腸炎は慢性疾患であり,もし再燃(一旦落ち着いた炎症が再度悪化すること)した場合は早めに検知し適切な治療介入を行うことにより,患者が社会生活をつつがなく送れるよう手助けをすることが,我々の任務である.外来診療で,再燃の可能性を予測するのはもちろんであるが,来院間隔は可能なら延ばしたく,今後は在宅自己管理も重要となってくる.大腸癌検診で普及している免疫学的便潜血検査は,潰瘍性大腸炎患者の大腸粘膜炎症の有無の判別にも有用であり,簡便な検査キットも開発されている.
    そこで,我々は,潰瘍性大腸炎患者による免疫学的便潜血検査の在宅自己測定は可能であるか,またその測定が再燃の早期予測に貢献し,予後向上に寄与できるかを明らかにするために研究を計画した.
    まず今期の研究では,潰瘍性大腸炎患者がキット(OC-ヘモキャッチ「栄研」)を用いて,自宅で便潜血定性検査を問題なく行うことができ,その測定結果が院内測定結果や大腸内視鏡所見(大腸粘膜の炎症所見)と一致するかの確認(①実施と精度の検証),さらに在宅自己測定の継続が可能かの検証(②継続性の検証)を行うこととした.
    ①実施と精度の検証:大腸内視鏡検査予定の潰瘍性大腸炎患者に検査1-3日前にキットで在宅便潜血検査を施行してもらう.そして,在宅自己測定結果が院内測定結果や大腸内視鏡所見と合致するかを検証する.現時点では予定症例の半数が実施済みであるが,ほぼ全例で在宅自己測定結果と院内測定結果は整合性を認めており,在宅測定の手技に関しても「思ったより簡単であった」との回答を得ている.②継続性の検証:臨床的寛解,内視鏡的粘膜治癒,便潜血陰性をすべて満たしている患者に,定期的な在宅便潜血検査と症状シート記入を1年間行ってもらう(原則2週間に1回).本検証は実施を開始したところである.

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  • Can the cell surface marker detected by our new culture system be a therapeutic target for inflammatory bowel disease (IBD)?

    Grant number:15K21179  2015.04 - 2018.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Young Scientists (B)  Grant-in-Aid for Young Scientists (B)

    Takahara Masahiro, Takaki Akinobu, Hiraoka Sakiko

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    Grant amount:\4030000 ( Direct expense: \3100000 、 Indirect expense:\930000 )

    We investigated whether CD25, which was detected by our new culture system, could be a therapeutic target on inflammatory bowel disease. The lamina propria (LP) CD4+ T cells of colitis mice were cultured under standard mitogen stimulation and collected. The collected LPCD4+T cells were compared to the inflammatory cytokines productions by flow cytometric analysis. Additionally, we sorted CD25 positive and negative cells from LPCD4+ T cells of colitis mice and transferred each fractions separately into new immunodeficiency mice and compared the severity of colitis.
    As the CD25 positive cells contain CD4+CD25+Foxp3+ regulatory T cells (Treg cells), we excluded the Treg cells fraction and compared the inflammatory cytokines production with the CD25 negative cells. The cytokines production was not different between the Treg negative CD25 positive cells and the CD25 negative cells fraction.We are now investigating the in vivo experiments.

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