Background To elucidate the relationship between gastroesophageal reflux disease and sleep disorders in the Japanese population, we conducted a nationwide survey on the prevalence of heartburn, the ...cardinal symptom of the disease, and sleep disorders. Methods Questionnaires regarding the frequency of heartburn and sleep disorders were distributed and endoscopic findings were assessed among patients who visited 35 participating institutions from March through September 2005, with a target sample size of 100 consecutive endoscopy patients per institution. Results A total of 2426 patients were included in the analysis population. The prevalence of gastroesophageal reflux disease in patients was 26.5% (n = 644). Mean sleeping time was 6.5 ± 1.2 h, and 48.3% (n = 1172) of all patients reported experiencing sleep disorders. Sleep disorders were significantly more prevalent among patients with heartburn, at 56.3% (615/1093 patients, P < 0.0001), with the number of sleep disorder events increasing with the frequency of heartburn. Conversely, those with sleep disorders reported experiencing heartburn at a significantly higher rate (approximately 75%). However, sleep disorders occurred in only 51.6% (197/382) of patients with reflux esophagitis, showing no significant difference compared with those without reflux esophagitis. No definite tendency was seen in relation to the severity of reflux esophagitis. Conclusions In Japanese people, patients with heartburn had a significantly higher prevalence of sleep disorders than those without heartburn.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
The present survey aimed to clarify the prevalence of gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) in patients presenting with epigastric symptoms in Japan based on ...the Montreal definition and the Rome III criteria, respectively, and to determine the degree of overlap between the two disease entities and the validity of using these Western-developed diagnostic criteria in Japan.
Methods
Patients presenting with epigastric symptoms for whom the first upper gastrointestinal endoscopy was scheduled from April through August 2007 at 55 institutions were asked to complete a questionnaire to ascertain the type, frequency, and severity of epigastric symptoms. The prevalence of esophageal mucosal damage was also determined from endoscopic findings.
Results
A total of 1,076 patients were included in the analysis population. There was a high degree of coincidence for all symptoms, with the mean number of symptoms per patient of 2.8. With strict application of the Montreal and Rome III definitions, symptomatic GERD accounted for 15.6% (168 patients), whereas FD accounted for 10.3% (111 patients), and the overlap between GERD and FD symptoms was less than 10%. However, when frequency and severity alone were considered in more broadly defined criteria, the overlap between GERD and FD symptoms was 30–40%.
Conclusion
A highly specific disease classification is possible when the Montreal definition and the Rome III criteria are strictly applied. On the other hand, the present survey highlighted a problem with the criteria whereby a definitive diagnosis could not be made in a substantial number of patients. This problem will require further research.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The treatment principle of endoscopic high reactive level laser treatment (HLLT) of the gastrointestinal tract is the vaporization and coagulation of the diseased lesion. Histological changes are ...caused by the photothermal reaction which is directly related to the increase of temperature of the laser-irradiated field. High outputs of 60 to 100 W can cause tissue to vaporize while outputs of 20 to 50 W can cause protein denaturation and coagulation. The amount and degree of tissue damage is dictated by the energy density (output x irradiation time/cm2) of the incident laser. At lower outputs of 2 to 3 W, laserthermia is anticipated, however using a high output hardware to achieve this is unadvisable and a specific hardware intended for this purpose should be used. When output of a laser mistaken, dangers of perforation and burning of the scope arise. The purpose of these Safety Guidelines is to provide information for the proper use of lasers in order to secure the safety of both the patient and the physician during the use of lasers in endoscopic procedures of the digestive tract.
AIM： Endoscopic metal stenting （EMS） offers good results in short to medium term follow-up for bile duct stenosis associated wfth chronic pancreatitis （CP）; however, longer follow-up is needed to ...determine if EMS has the potential to become the treatment of first choice.
METHODS： EMS was performed in eight patients with severe common bile duct stenosis due to CP. After the resolution of cholestasis by endoscopic naso-biliary drainage three patients were subjected to EMS while, the other five underwent EMS following plastic tube stenting. The patients were followed up for more than 5 years through periodical laboratory tests and imaging techniques.
RESULTS： EMS was successfully performed in all the patients. Two patients died due to causes unrelated to the procedure： one with an acute myocardial infarction and the other with maxillary carcinoma at 2.8 and 5.5 years after EMS, respectively. One patient died with cholangitis because of EMS clogging 3.6 years after EMS. None of these three patients had showed symptoms of cholestasis during the follow-up period. Two patients developed choledocholithiasis and two suffered from duodenal ulcers due to dislodgement of the stent between 4.8 and 7.3 years after stenting; however, they were successfully treated endoscopically. Thus, five of eight patients are alive at present after a mean follow-up period of 7.4 years.
CONCLUSION： EMS is evidently one of the very promising treatment options for bile duct stenosis associated with CP, provided the patients are closely followed up; thus setting a system for their prompt management on emergency is desirable.
Background The Bravo system was mainly designed to monitor esophageal pH, and there have been no reports about gastric pH monitoring when using this system. We attempted to place the Bravo capsule ...onto the gastric wall and monitor gastric pH in ambulatory patients and healthy volunteers. Materials and methods The Bravo system was introduced into the esophagus and the stomach along a thin endoscope, and the capsules were then attached, one each to the esophageal and gastric walls under direct vision through the endoscope. The subjects were 11 volunteers (9 men and 2 women, mean age 38; 3 had symptoms of GERD), in whom esophageal and gastric pHs were simultaneously monitored. Results The 2 capsules were successfully placed in 10 of the 11 subjects, and both esophageal and gastric pHs were monitored for 48 hours in 9 subjects. Mild to moderate precordial pain was observed in 7 subjects, but no other complications or side effects were observed in this study. The gastric pH of 10 subjects increased after meals and returned to baseline pH 2 hours later. A decrease of esophageal pH was observed 1 hour after a meal in the symptomatic subjects, and it corresponded to the time when gastric pH decreased secondary to the increase of pH with meals. Conclusions The Bravo capsule was easily placed onto the gastric wall under endoscopic assistance, and this enables long ambulatory monitoring of gastric pH.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Antiangiogenic factors are potent endothelial cell growth inhibitors that have been shown to inhibit angiogenesis in vitro and tumor growth in mice. We have demonstrated the synergistic antitumor ...effect of antiangiogenic genes (mouse angiostatin: pBLAST-mAngio; and mouse endostatin: p-BLAST42-mEndo XV) delivered to tumors by low-voltage electroporation in mouse colon 26 models. A synergistic antitumor effect was strongly suggested by in vivo tumor growth kinetics, as well as in survival studies with the mice. RT-PCR confirmed that the fragments of each gene were transferred by low-voltage electroporation in the tumor. Decreased microvessel density measurements in tumors also confirmed the efficacy of the synergistic antitumor effect of both genes. Significant growth inhibition was observed in mice treated with a 1:1 proportion of angiostatin and endostatin genes, and the order of the both genes transferred (first the endostatin gene, followed 1 week later by the angiostatin gene) had a profound inhibitory effect on tumor growth. These data suggest that in vivo delivery of antiangiogenic genes with low-voltage electroporation could be a possible therapeutic strategy for established solid tumors when both genes were applied in combination.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The antitumor efficiency of electrochemotherapy using chemotherapeutic agents and high-voltage electric pulse has been reported. This study was done to define the precise nature of the involvement of ...antitumor immunity in the regression of tumor nodules in electrochemotherapy, and to evaluate the effectiveness of using low-voltage electroporation.
Balb/c mice and Balb/c nu/nu nude mice were inoculated subcutaneously with Colon 26 cells or Meth A cells. Electrochemotherapy using bleomycin and low-voltage electroporation (CUY21) was performed as a treatment against tumor nodules.
Colon 26 tumors were eradicated in the mice given an intratumor (i.t.) injection of 500 microg bleomycin followed by treatment with electric fields ranging from 50 to 150 V/cm, with complete response rates ranging from 80% to 100%. The mice rejected inoculations of rechallenged Colon 26 cells, but not Meth A cells. In the Balb/c nu/nu nude mice, complete regression of the tumor was not seen after electrochemotherapy under the same therapeutic conditions that resulted in almost complete cure in the Balb/c mice.
Our results suggest that the generation of T-cell-dependent, tumor-specific protective immunity might be involved in the process of tumor nodule regression in low-voltage electrochemotherapy.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We investigated the antitumor effects induced by the production of interleukin-12 (IL-12) or IL-18, which influence the function of T helper type 1 cells, in murine colon carcinoma cells (Colon 26). ...Retrovirally transduced cells with IL-12 genes that encoded both p35 and p40 (Colon 26/IL-12) lost their tumorigenicity when inoculated subcutaneously or intraperitoneally into syngeneic immunocompetent mice. Moreover, the mice that had rejected the Colon 26/IL-12 cells generated protective immunity to wild-type (wt) cells when subsequently challenged. Colon 26 cells transduced with the IL-18 gene (Colon 26/IL-18) could not form subcutaneous tumors in immunocompetent mice, and the mice became resistant to inoculated wt cells. Immunohistochemical analysis revealed that the numbers of blood vessels in Colon 26/IL-12 or Colon 26/IL-18 tumors were markedly reduced, and that the expression of adhesion molecules such as intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 increased on the endothelium in the stroma of Colon 26/IL-12 tumors. The loss of tumorigenicity of Colon 26/IL-12 or Colon 26/IL-18 cells was not observed in immunocompromised mice. However, the survival days of the immunocompromised mice inoculated with Colon 26/IL-12 but not Colon 26/IL-18 cells were significantly longer than those inoculated with wt cells. The secretion of cytokines that stimulate T helper type 1 cells from tumor cells can thereby induce an antitumor response. However, the effector cells involved in these antitumor effects could differentially migrate to the tumors, and the inhibition of angiogenesis may partially contribute to the antitumor responses observed.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We conducted a epidemiological survey in 2, 595 patients who underwent endoscopy for the first time, confirming that Barrett's mucosa was observed in 536 (20.8%) of 2, 577 patients. The length of ...Barrett's mucosa was significantly longer in female patients than that in male patients. No correlation was observed between the prevalence of Barrett's mucosa and age group. Meanwhile, correlations were observed between the presence or absence of Barrett's mucosa and heartburn, and between the length of Barrett's mucosa and the severity of ref lux esophagitis or esophageal hiatus hernia. In addition, atrophic gastritis affected length of Barrett's mucosa. These findings suggested that ref lux esophagitis played an important role for the occurrence of Barrett mucosa. However, the prevalence of typical Barrett's esophagus was markedly low in the Japanese compared with Westerner. It is necessary to standardize the definition of Barrett's mucosa and accumulate the evidence based on the diagnostic criterian.
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