Clinical Study Infliximab Extends the Duration until the First Surgery in Patients with Crohn's Disease

Background/Aims. While biological drugs are useful for relieving the disease activity and preventing abdominal surgery in patients with Crohn's disease (CD), it is unclear whether the use of biological drugs in CD patients with no history of abdominal surgery is appropriate. We evaluated the effects of infliximab and other factors on extending the duration until the first surgery in CD patients on a long-term basis. Methods. The clinical records of 104 CD patients were retrospectively investigated. The cumulative nonoperation rate until the first surgery was examined with regard to demographic factors and treatments. Results. The 50% nonoperative interval in the 104 CD patients was 107 months. The results of a univariate analysis revealed that a female gender, the colitis type of CD, and the administration of corticosteroids, immunomodulators, or infliximab were factors estimated to improve the cumulative nonoperative rate. A multivariate analysis showed that the colitis type and administration of infliximab were independent factors associated with a prolonged interval until the first surgery in the CD patients with no history of abdominal surgery. Conclusions. This study suggests that infliximab treatment extends the duration until the first surgery in CD patients with no history of abdominal surgery. The early use of infliximab before a patient undergoes abdominal surgery is therefore appropriate

Infliximab Extends the Duration until the First Surgery in Patients with Crohn’s Disease

Background/Aims. While biological drugs are useful for relieving the disease activity and preventing abdominal surgery in patients with Crohn’s disease (CD), it is unclear whether the use of biological drugs in CD patients with no history of abdominal surgery is appropriate. We evaluated the effects of infliximab and other factors on extending the duration until the first surgery in CD patients on a long-term basis. Methods. The clinical records of 104 CD patients were retrospectively investigated. The cumulative nonoperation rate until the first surgery was examined with regard to demographic factors and treatments. Results. The 50% nonoperative interval in the 104 CD patients was 107 months. The results of a univariate analysis revealed that a female gender, the colitis type of CD, and the administration of corticosteroids, immunomodulators, or infliximab were factors estimated to improve the cumulative nonoperative rate. A multivariate analysis showed that the colitis type and administration of infliximab were independent factors associated with a prolonged interval until the first surgery in the CD patients with no history of abdominal surgery. Conclusions. This study suggests that infliximab treatment extends the duration until the first surgery in CD patients with no history of abdominal surgery. The early use of infliximab before a patient undergoes abdominal surgery is therefore appropriate

A Bamboo Joint-Like Appearance is a Characteristic Finding in the Upper Gastrointestinal Tract of Crohn's Disease Patients

the Creative Commons Attribution License 4.0The clinical importance of Crohn's disease (CD)-specific lesions in the upper gastrointestinal tract (upper GIT) has not been sufficiently established. The aim of this case-control study is to investigate the characteristic findings of CD in the upper GIT. In 2740 patients who underwent gastroduodenoscopy at Asahikawa Medical University between April 2011 and December 2012, 81 CD patients, 81 gender- and age-matched non-IBD patients, and 66 ulcerative colitis (UC) patients were investigated in the present study. (1) The diagnostic ability and odds ratio of each endoscopic finding (a bamboo joint-like appearance in the cardia, erosions, and/or ulcers in the antrum, notched signs, and erosions and/or ulcers in the duodenum) were compared between the CD and non-IBD patients or UC patients. (2) The interobserver agreement of the diagnosis based on the endoscopic findings was evaluated by 3 experienced and 3 less-experienced endoscopists. The incidence of detecting a bamboo joint-like appearance, notched signs, and erosions and/or ulcers in the duodenum was significantly higher in the CD patients than in the non-IBD and UC patients. In addition, the diagnostic ability and odds ratio of a bamboo joint-like appearance for CD were higher than those for the other findings. Kendall's coefficients of concordance in the group of experienced and less-experienced endoscopists were relatively high for a bamboo joint-like appearance (0.748 and 0.692, respectively). A cardiac bamboo joint-like appearance is a useful finding for identifying high-risk groups of CD patients using only gastroduodenoscopy

CTにて病変の指摘が困難でEUSにて描出が可能であった膵腫瘍の2例 膵病変診断におけるEUSの有用性

雑誌掲載版症例1(76歳男性).定期採血にて血清アミラーゼ高値を指摘された.症例2(58歳女性).糖尿病・高血圧の治療中,膵頭部嚢胞性病変を指摘された.1)両症例ともERCPにて膵頭体移行部主膵管の狭窄と尾側膵管の拡張が認められたが,CTでは腫瘤の指摘は困難であった.2)いずれもEUSにて膵頭部に約20mm大の内部不均一な低エコー腫瘤が確認され,膵腫瘍が疑われた.3)治療として症例1はPpPDを,症例2は膵体尾部切除術を施行した.病理組織学的に症例1は浸潤性膵管癌(TS 1)で,症例2は膵グルカゴーマであっ

高齢者食道癌に対する化学放射線療法の治療成績

雑誌掲載版食道癌は悪性度が高く治療困難な癌のひとつであるが、積極的な治療効果向上の努力の結果、外科手術、内視鏡治療、化学放射線治療がめざましく進歩してきた。食道癌の特徴のひとつとして高齢者に多く発生することがあげられる。治療の問題点として、リンパ節郭清や再建臓器の点で外科手術の侵襲がきわめて高いことがあげられる。しかし、食道癌は他の消化器癌に比較して抗癌剤や放射線の感受性が高く、積極的に化学放射線療法が選択されることが多い。1998年1月から2011年12月までに筆者らが化学放射線治療を実施した高齢者食道癌症例を集計し、その効果と長期予後について検討した。化学放射線治療を行った45症例(55〜81歳)のうち、65歳以上の高齢者は26症例(57.8%)みられた。高齢者食道癌の進行度別内訳は、stage I 6例、stage II 3例、stage III 8例、stage IV 9例で、外科切除可能と考えられるstage III以下の症例が17例含まれていた。放射線療法は54〜66Gyの線量で、化学療法は5-FU/CDDPが多く、23例で治療が完遂できた。全生存期間の中央値は30.1ヵ月であり、治療効果がCRに至った14例(56.0%)の生存期間は100.5ヵ月であった。高齢者の食道癌患者は化学放射線治療を実施されることが多く、治療効果は良好であった。PR、SD症例は食道癌の再発により死亡していたが、CR症例は長期予後が得られた。高齢者食道癌においても化学放射線療法を実施する際にはCRを目指して積極的に治療することが重要と考えられた

A Randomized Study on the Effectiveness of Prophylactic Clipping during Endoscopic Resection of Colon Polyps for the Prevention of Delayed Bleeding

(CC BY-SA 3.0)BACKGROUNDS: The efficacy of clipping for preventing the delayed bleeding after the removal of colon polyps is still controversial. In order to clarify this efficacy, a randomized controlled study was performed. METHODS: One hundred and fifty-six patients with colon neoplasms (288 lesions) were enrolled in the study. The patients were randomly divided into two groups: clipping or nonclipping groups using a sealed envelope method before the endoscopic resections. Eight specialists and nine residents were invited to perform this procedure. The risk factors and the rates of delayed bleeding after the endoscopic resections in each group were investigated. RESULTS: There were no significant differences in the bleeding rate between the clipping and nonclipping groups, while the length of the procedure was significantly longer and the cost was higher in the clipping group than in the nonclipping group. The rate of bleeding was significantly higher in cases with polyps 2 cm or larger and with a longer procedure time, while none of the other factors affected the bleeding rate. CONCLUSIONS: This randomized controlled study revealed no significant effect of prophylactic clipping for preventing delayed bleeding after the endoscopic resection of colon polyps