Review Article Gastritis with Distinctive Histopathology (Non-Helicobacter Pylori Gastritis)

Distinctive gastritis refers to gastritis with distinctive histological and endoscopic features, including the presence of granulomas, the increased number of intraepithelial lymphocytes, eosinophilic infiltration, thickening of the subepithelial collagen band, and foveolar hyperplasia. Several forms of distinctive gasatritis are reviewed in this issue, since understanding of its pathogenesis and the accurate diagnosis are implicated in clinical prognostic biomarkers and lead to a new therapeutic approach

Review Article Is Biopsy Necessary if Colonoscopy is Normal in Patients With Chronic Unexplained Diarrhea?

Endoscopy and biopsy are important diagnostic tools in the evaluation of patients with chronic diarrhea and normal colonic mucosa. When colonoscopy is performed in patients with diarrhea and normal endoscopic appearance, representative sampling is important to rule out not just irritable colon but other conditions such as inflammatory bowel disease, collagenous colitis, lymphocytic colitis, eosinophilic colitis and amyloidosis. Clinically important histological lesions can be identified in a significant proportion of patients in spite of normal or nonspecific colonoscopic findings, which justifies routine mucosal biopsy in the evaluation of patients with chronic diarrhea. It is recommended that when colonoscopy is performed for the evaluation of patients with diarrhea of unknown cause and mucosa appears normal, five biopsy sites be sampled, including the cecum, transverse colon, descending colon, sigmoid colon and rectum

Endoscopic Polypectomy of Esophageal Leiomyomas; Report of Two Cases

We describe esophageal leiomyomas in two young patients (aged 35 and 32 years), who complained of dysphagia and epigastralgia, which were successfully treated by endoscopic polypectomy. Upper endoscopy showed a pedunculated polyp beneath the normal mucosa located at 28 cm from the incisor in the first case and 1 cm sessile 2.1 cm semipedunculated polypoid lesion in the lower esophagus just above the esophageal-gastric junction in the second case. Both lesions were resected by snare polypectomy without any complication. Light microscopic examination and immunohistochemistry of the tumor tissue confirmed the diagnosis of leiomyoma. Endoscopic polypectomy of esophageal leiomyoma is safe and should be considered as an optional treatment modality whenever possible

Response to Urinary Trypsin Inhibitor Therapy in Ulcerative Colitis is Associated With a Decrease in Mast Cell Count in the Colonic Mucosa

BACKGROUND: Urinary trypsin inhibitor (UTI, ulinastatin (R)) inhibits proteinases and has been used for the treatment of ulcerative colitis (UC). We investigated the therapeutic effect of UTI in patients with UC and correlated this effect to mast cell (MC) and macrophages (M) counts in the colonic mucosal wall. DESIGN: Patients with UC resistant to corticosteroids (n=16) and normal control subjects (n=10) were included in this study. Biopsy specimens obtained from the sigmoid colon of patients before and after UTI therapy were immunostained with antibodies to tryptase (AA1, MC) and CD68 (M). The number of MC and M in the lamina propria (LP) was determined and expressed per mm2 of LP. RESULTS: Nine patients with UC responded to UTI treatment. The mean number of MC in the upper part of LP in responders(440ﾂｱ51/mm2)was higher than nonresponders (312ﾂｱ76/mm2)and normal controls(200ﾂｱ47/mm2). MC counts in the lower part of the LP were not different in responders and nonresponders, although the counts in both groups were significantly higher than control. The number of M in the lower part of LP was similar in responders and nonresponders, but were higher than control subjects. M counts in the upper part of LP were similar in both groups of patients and control. Effective treatment with UTI in responders was associated with a significant fall in the number of MC in the upper layer of LP but not in M. CONCLUSION. Our results showed that UTI is an effective therapy in steroid-resistant UC. Our results also showed effective therapy with UTI was associated with a reduction in MC counts in the colonic mucosa, suggesting that the control of these cells may mediate, at least in part, the therapeutic effects of UTI in UC

Significance of Impairment of Antioxidants in Colonic Epithelial Cells Isolated From TNBS-Iuduced Colitis Rats

The functional status of glutathione (GSH), its related enzymes and Cu, Zn-superoxide dismutase (SOD) in colonocytes isolated from trinitrobenzene sulphonic (TNBS)-induced colitis rats was studied. Colitis (T group) was induced in Wistar rats with 42 mg TNBS dissolved in 0.35 ml of 40% (v/v) ethanol instilled into the colon. The animals were sacrificed on day 14 and compared with saline-instilled rats (S group). The GSH concentration and the enzymatic activities of glutathione peroxidase (GPx), glutathione S-transferase (GST), and SOD were spectrophotometrically estimated. The severity of colitis was assessed histologically and by myeloperoxidase activity (MPO) in whole colonic tissue. The body weight loss of the rats in the T group was marked. In colonocytes isolated from rats in the T group, the concentration of GSH (7.9 ±1.4 vs.11.3 ± 0.4 nmol/mg protein, p < 0.05) and the activities of GST (104.4 ± 10.3 vs. 146.2 ± 18.5 mU/mg protein, p < 0.05) and SOD (74.4 ± 8.9 vs. 99.8 ± 7.5U/mg protein, p < 0.05) were lower, but the activity of GPx (430.0 -±14.1 vs. 283.9 ± 10.0 mU/mg protein, p < 0.05) was higher than in the S group. As expected, the activity of MPO in the T group was higher than in the S group (371.2 ± 14.7 vs. 158.9 ± 8.4 mU/mg tissue, p<0.05) and histologically, colitis was only observed in rats in the T group. In conclusion, the functional status of antioxidants in the colonic epithelial cells of rats challenged with TNBS solution is impaired. This impariment may make them more susceptible to oxidative damage that may contribute to the development of the lesions observed in this model. Further studies at the molecular level are necessary to investigate these novel findings in this model and their potential application for testing new therapeutic approaches in inflammatory diseases of the intestinal tract

Spontaneous Regression of Colonic Lesions in Adult T-cell Leukemia

A 74-year-old man was admitted to our hospital because of diarrhea. Serum anti-HTLV-1 antibody was positive without abnormal lymphocytes. Colonoscopy demonstrated a edematous and congested mucosa with erosions, and ulcers in the region extending from the cecum to rectum. Biopsy specimens showed diffuse infiltration of abnormal lymphocytes positive for T-cell markers in the lamina propria. Conservative therapy was provided but no chemotherapy because of improvement of diarrhea within two weeks. A repeat colonoscopy 6 months later revealed scars without erosions or ulcers. Eight months after first admission, the patient was readmitted to our hospital because of acute ATL crisis, and died of hepatic involvement 7 days later. Colonic lesions associated with ATLS may show spontaneous regression and recurrence

Association of serum gamma-glutamyltransferase (GGT) and diabetes with triglycerides-to-HDL cholesterol ratio in Japanese subjects: The Nagasaki Study

Background: Although we reported in a previous study that diabetes with a high serum triglycerides to high-density lipoproteincholesterol (TG-HDL) ratio constitutes a risk for atherosclerosis, associations in terms of TG-HDL ratio between diabetes and gamma-glutamyltransferase (GGT), which is also known as an independent risk factor for atherosclerosis, have not yet been clarified. The purpose of this study was to test the hypothesis that a positive association between GGT and diabetes may be confined to high TG-HDL. Methods: This was a cross-sectional study of 2,302 Japanese subjects who were undergoing a general health check in 2014. All subjects were divided into TG-HDL level tertiles and serum GGT and diabetes status were investigated. Results: Of 207 diabetes patients identified in this study, 94 had high TG-HDL, 63 intermediate TG-HDL, and 50 low TG-HDL. Independent of classical cardiovascular risk factors, serum GGT showed a positive association with diabetes in patients with high TG-HDL, but not in patients with intermediate and low TG-HDL diabetes. The multivariable adjusted odds ratios (OR) and 95% coincidence intervals (95%CI) of diabetes for 1 standard deviation (SD) increment of GGT were 1.64 (95%CI: 1.16-2.31) for high TG-HDL, 1.46 (95%CI: 0.95-2.26) for intermediate TG-HDL, and 1.04 (95%CI: 0.60-1.79) for low TG-HDL diabetes. Conclusion: Serum GGT is positively associated with diabetes in patients with high TG-HDL but not with intermediate or low TG-HDL diabetes. This finding may prove to be an efficient tool for estimating atherosclerotic risk in diabetes patients

Hemoglobin as a response marker of endothelial cell damage in elderly nonoverweight non-anemic subjects.

　An independent positive correlation between hemoglobin level and risk of hypertension has been reported for non-anemicnon-overweight men and women. Additionally, serum hepatocyte growth factor (HGF) concentration in hypertensive subjects was reported to be significantly higher than in normotensive subjects. However no studies have reported on the correlation betweenhemoglobin and HGF. A cross-sectional study of 695 elderly non-overweight non-anemic Japanese subjects (231 men and 464 women; range 60-92 years old; Body mass index (BMI)<25kg/m2; Hemoglobin (Hb)?13g/dL for men and Hb?12g/dL for women) who were undergoing general health checkups in 2014 was conducted. Multiple linear regression analysis adjustment for classical cardiovascular risk factors showed a significant positive correlation between hemoglobin and serum HGF concentration(parameter estimate (β) =31.8, P<0.001) for men and (β=21.7, P<0.001) for women. An independent positive correlation between hemoglobin and HGF was observed in elderly non-anemic non-overweight Japanese subjects. Since HGF level may become elevated in response to endothelial cell damage (vascular remodeling), these findings suggest that measuring hemoglobin level is clinically relevant for estimating the response to endothelial cell damage

Adenocarcinoma of the Colon Presenting as Intussusception In Adult: Report of Two Cases

We present two adult cases of intussusception caused by adenocarcinoma of the colon. These cases represent typical cases of adult intussusception, a rare disease characterized by insidious onset, vague abdominal symptoms, and elusive diagnosis. On physical examination, the masses were palpable in the right hypochondrium. Colonic intussusception were diagnosed by characteristic finding on ultrasonography (US) and computer tomography (CT). Endoscopic examination showed pedunculated tumors with central ulceration, in the cecum, which caused colonic intussusception, and endoscopic biopsies showed adenocarcinoma of the colon. US and CT are useful non-invasive diagnostic tools that allow early detection of intussusception. Colonoscopy is recommended for differential diagnosis and possibly a direct reduction of intussusception

Hepatocellular Carcinoma with Direct Invasion to the Duodenal Bulb, Presenting with Gastrointestinal Bleeding

Hemorrhage from hepatocellular carcinoma (HCC) directly invading the gastrointestinal tract is very rare. A 71-yearold man, who had been treated with transcatheter arterial embolization and percutaneous ethanol injection for HCC in the right hepatic lobe, presented with melena. Endoscopic examination showed a crater-like ulceration coated with blood clot in the duodenal bulb, and microscopic examination of a biopsy specimen from the duodenal lesion confirmed HCC. Abdominal computed tomography (CT) revealed that the HCC mass containing air-density invaded the duodenum. Recurrent bleeding continued from the lesion and the patient died of liver failure. Postmortem examination revealed massive HCC with hepatoduodenal fistula caused by direct tumor invasion into the duodenum