Preliminary Trial of Rebamipide for Prevention of Low-Dose Aspirin-Induced Gastric Injury in Healthy Subjects: A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Study

Although low-dose aspirin is widely used, since it is a cheap and effective means of prevention of cardiovascular events, it can cause hemorrhagic gastrointestinal complications. The aim of this study was to evaluate the efficacy of rebamipide in preventing low-dose aspirin-induced gastric injury. A randomized, double-blind, placebo-controlled, crossover trial was performed in twenty healthy volunteers. Aspirin 81 mg was administered with placebo or rebamipide 300 mg three times daily for 7 consecutive days. The rebamipide group exhibited significant prevention of erythema in the antrum compared with the placebo group (p = 0.0393, respectively). Results for the body and fornix did not differ significantly between the placebo and rebamipide groups. In conclusion, short-term administration of low-dose aspirin induced slight gastric mucosal injury in the antrum, but not in the body or fornix. Rebamipide may be useful for preventing low-dose aspirin-induced gastric mucosal injury, especially which confined to the antrum

頭頸部領域および食道領域の各種症状に対する食道運動機能の関与について : High Resolution Manometry を用いた検討

頭頸部領域および食道領域における各種症状に対する食道運動機能の関与を検討した.2007年9月から2012年6月までに,咽喉頭異常感などの頭頸部領域の症状および嚥下困難感,胸痛,胸やけなどの食道領域に関連した症状を主訴に,当科を受診した261例(男性138例,女性123例,平均年齢56.8±17.1才)を対象とし,健康関連QOL(Health Related Quality of Life: HRQL)の測定と食道内圧検査を施行した.健康関連QOLの検討では,咽喉頭違和感,嚥下困難感,胸やけ等の各症状を訴えた患者で,身体的QOL,精神的QOL を表すPCS(physical component summary)あるいはMCS(mental component summary)が低下し,健常者と比較して有意にQOLの低下を認めた.食道内圧検査による食道運動機能異常は,全対象患者中62.0%に認めた.各症状別に食道運動機能障害の内訳を見ると,咽喉頭違和感ではIEM(ineffective esophageal motility)(31.8%),嚥下困難感は食道アカラシア(56.6%),喉のつかえ感は食道アカラシア(35.5%),胸やけはIEM(39.4%),胸痛は食道アカラシア(50.0%),噫気はIEM(50.0%)を最も多く認めた.咽喉頭違和感,嚥下困難感,喉のつかえ感,胸やけ,胸痛などの頭頚部および食道症状を有するものの,器質的疾患を認めない患者のQOLは障害されており,その病態の一つとして食道運動機能異常の存在を念頭に置き,診療にあたることが重要である.There are many cases of patients presenting at the hospital complaining of dysphagia or chest pain. At that time organic diseases are not always detected in these patients;previously several studies showed esophageal motility dysfunction was one of the important factors in the development of these symptoms. However, there have been few reports investigating the relationship between esophageal motility dysfunction and these symptoms. Between September 2007 and June 2012, 216 patients (138 men,123 women;mean age 56.8±17.1 years old) were admitted complaining of the following symptoms:dysphagia, globus sensation, or heart burn and non-cardiac chest pain,but without any organic diseases related symptoms. They all underwent high-resolution esophageal manometry (HRM) and completed a questionnaire regarding their health-related quality of life (HRQOL). The aim of this study was to evaluate the relationship between these symptoms and esophageal motility dysfunction and QOL. In our series, 62% of patients with non-obstructive dysphagia, globus sensation, heartburn and unexplained (non-cardiac) chest pain have an esophageal motility disorder (Achalasia 31.5%, IEM 26.4%, Diffuse esophageal spasm 4.6%;nutcracker esophagus 2.8% and Impaired ECJ relaxation 0.5%). SF-8 score of PCS(Physical Component Summary) in all of the symptoms were significantly lower in comparison with the matched healthy control. SF-8 score of MCS(Mental Component Summary) with globus sensation and esophageal dysphagia were significantly lower in comparison with the matched healthy control. The patients complaining of several symptoms located in the pharynx or esophagus have impaired quality of life and esophageal motility dysfunctions.It is important to consider these issues while examining these patients

Pathophysiological Classification of Functional Dyspepsia Using a Novel Drinking-Ultrasonography Test

Background: Functional dyspepsia (FD) is a heterogeneous disease characterized by various upper abdominal symptoms. The major mechanism of FD symptoms includes impaired fundic accommodation, delayed gastric emptying, and visceral hypersensitivity. We developed a novel drinking-ultrasonography to combine a drink test with ultrasonography to assess gastric motility and sensory function of FD patients. Method: Subjects were sixty successive FD patients according to the Rome III criteria. A drinking-ultrasonography test was performed after subjects had fasted. The subjects ingested 200 ml of water at two-minute intervals four times (total 800 ml) through a straw. The maximum cross-section of the proximal stomach was visualized before water intake, after each water intake, and 5 and 10 minutes after the completion of drinking using extracorporeal ultrasonography. Abdominal symptoms were evaluated using the visual analog scale (VAS) a total of 5 times. Normal range of cross-sectional area and VAS were set using average ±2 standard deviations of 33 healthy volunteers. Cases outside the normal range were diagnosed with a motor or sensory disorder. Results: The drinking-ultrasonography test classified FD patients into four groups without adverse effect or trouble. The distribution of each group was 27% in the normal group, 15% in the impaired relaxation group, 10% in the delayed emptying group, and 48% in the visceral hypersensitivity group. There was no significant correlation between the pathophysiological classification and subtypes of FD defined by the Rome III criteria. Conclusion: We developed a novel drinking-ultrasonography test that was effective in classifying FD patients according to pathophysiological features

Analgesic effects of indomethacin spray on drug-induced oral mucositis pain in patients with cancer: A single-arm cross-sectional study

Aims: Symptomatic treatment is insufficient for chemotherapy- or targeted therapy-induced oral mucositis (OM) pain, and benzydamine mouthwash is not commercially available in Japan. We evaluated the analgesic effects of an in-hospital preparation of 0.25% indomethacin spray (IMS) on anticancer drug-induced OM pain. Methods: This single-arm prospective trial enrolled 20 patients (median age 62.0 years) with OM and numerical rating scale scores of >= 5 who were undergoing chemotherapy or targeted therapy in our hospital. Pain scores were recorded using a visual analog scale (VAS) before and 30 min after IMS administration. Pain relief (PR) scores were recorded at 15, 30, and 60 min after IMS administration; total PR after 60 min (TOTPAR(60)) was calculated, and the mean PR score after 3 days (PR3days) was determined. Results: The median (interquartile range) OM grade of the participants was 2.0 (2.0-2.3). The VAS score decreased significantly at 30 min after IMS administration (p = .001). The median (interquartile range) TOTPAR(60) and PR3days were 6.0 (3.8-7.3) and 2.0 (2.0-3.0), respectively. Conclusions: IMS helped improve patients' quality of life. The risk of systemic adverse effects was low because of the low dose administered. IMS effectively relieved anticancer drug-induced OM pain and may be useful for immediate self-medication

Increase in participation of vasoactive intestinal peptide in relaxation of the distal colon of Wistar rats with age

1. Changes in participation of vasoactive intestinal peptide (VIP) in nonadrenergic noncholinergic (NANC) relaxation of longitudinal muscle of the distal colon with age were studied in 2- to 50-week-old Wistar rats in vitro. 2. The extent of the VIP-mediated component of the relaxation induced by electrical field stimulation (EFS) was determined by the effect of VIP(10–28), a VIP receptor antagonist. In 2-week-old rats, the extent of the VIP-mediated component of the relaxation was scarce, about 10%, whereas the component gradually increase with age and reached the maximum extent 66% at 50-week-old. 3. Since our previous results suggest that VIP induces NANC relaxation via activation of charybdotoxin (ChTx, a blocker of large conductance Ca(2+)-activated K(+) channel)-sensitive K(+) channels with concomitant slow hyperpolarization in the muscle cells, we next studied whether ChTx-sensitive component and slow hyperpolarization changes with age. Extent of ChTx-sensitive component of the relaxation increased with age, showing a very similar pattern to VIP-mediated one. 4. EFS induced monophasic inhibitory junction potentials (i.j.ps) in longitudinal muscle cells of the distal colon of 2- and 4-week-old. EFS also induced biphasic i.j.ps in many longitudinal muscle cells of 8- and 50-week-old: rapid and subsequent slow hyperpolarization. A VIP receptor antagonist selectively inhibited the slow hyperpolarization. 5. Exogenously added VIP induced no appreciable change in the membrane potential of longitudinal muscle cells of 2-week-old, whereas it induced slight slow hyperpolarization of the cell membrane in 4-week-old and magnitude of the hyperpolarization increased with age. On the other hand, relaxant response of the longitudinal muscle to exogenously added VIP was high in younger rats. 6. The present results suggest that the role of VIP in mediating NANC relaxation of longitudinal muscle of the Wistar rat distal colon is very little at neonatal stage, but it increases with age