Faculty Profiles - HIRAOKA Sakiko

Papers - HIRAOKA Sakiko

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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

Language：Japanese Publisher：(株)先端医学社

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

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

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

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.

DOI： 10.1111/jgh.15288

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

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

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

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

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

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

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

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

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

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

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

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

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

Three cases of diverticula-related granulation polyp in the colon

Masaya Iwamuro, Takehiro Tanaka, Tomohiro Toji, Shumpei Yamamoto, Mami Hirai, Shohei Oka, Sakiko Hiraoka, Yoshiro Kawahara, Hiroyuki Okada

Gastroenterological Endoscopy 62 ( 12 ) 3057 - 3063 2020.12

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Gastroenterological Endoscopy Society

Granulation polyps are found in the colorectum often in association with postoperative anastomotic sites or scars after endoscopic resection. Meanwhile, few cases of granulation polyps that occur in relation to colonic diverticula have been reported. Herein, we report three cases of diverticula-related granulation polyps in the colon. In all three cases, a reddish polyp that protruded from a diverticulum was found in the sigmoid colon. White exudate and tortuous capillaries were observed on the surface of the polyps. On magnifying endoscopic observation, the surface structure was unclear or had disappeared. We speculate that these endoscopic features are specific to granulation polyps in the colon. It is noteworthy that in one patient with laryngeal cancer, the polyp was false-positive for a tumor on positron emission tomography, showing significant tracer accumulation. Differentiation of granulation polyp from cancer metastasis to the colon is important in such patients. It is essential to be able to make a precise diagnosis of diverticula-related granulation polyp in the colon based on endoscopic features.

DOI： 10.11280/gee.62.3057

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

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

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)

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

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

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

DOI： 10.18926/AMO/60363

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

平岡佐規子, 安富絵里子, 岡昌平, 井口俊博, 高原政宏, 岡田裕之

臨床消化器内科 35 ( 10 ) 1256 - 1262 2020.8

Language：Japanese Publisher：(株)日本メディカルセンター

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

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

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

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.

DOI： 10.2169/internalmedicine.3628-19

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

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

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

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

DOI： 10.3892/etm.2020.8538

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

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

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.

DOI： 10.2169/internalmedicine.3633-19

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

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

Language：English

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.

DOI： 10.1155/2020/8893604

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

Language：English

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.

DOI： 10.18926/AMO/57377

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

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

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.

DOI： 10.3390/cancers11020213

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

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

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.

DOI： 10.18926/AMO/56463

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