AIM:To determine the difference in clinical outcome between ulcerative colitis(UC)patients with Mayo endoscopic subscore(MES)0 and those with MES 1.METHODS:UC patients with sustained clinical remission of 6 mo or more...AIM:To determine the difference in clinical outcome between ulcerative colitis(UC)patients with Mayo endoscopic subscore(MES)0 and those with MES 1.METHODS:UC patients with sustained clinical remission of 6 mo or more at the time of colonoscopy were examined for clinical outcomes and the hazard ratios of clinical relapse according to MES.Parameters,including blood tests,to identify predictive factors for MES 0and slight endoscopic recurrence in clinically stablepatients were assessed.Moreover,a receiver operating characteristic curve was generated,and the area under the curve was calculated to indicate the utility of the parameters for the division between complete and partial mucosal healing.All P values were two-sided and considered significant when less than 0.05.RESULTS:A total of 183 patients with clinical remission were examined.Patients with MES 0(complete mucosal healing:n=80,44%)were much less likely to relapse than those with MES 1(partial mucosal healing:n=89,48%)(P<0.0001,log-rank test),and the hazard ratio of risk of relapse in patients with MES 1 vs MES0 was 8.17(95%CI:4.19-17.96,P<0.0001).The platelet count(PLT)<26×104/μL was an independent predictive factor for complete mucosal healing(OR=4.1,95%CI:2.15-7.99).Among patients with MES 0 at the initial colonoscopy,patients of whom colonoscopy findings shifted to MES 1 showed significant increases in PLT compared to those who maintained MES 0(3.8×104/μL vs-0.6×104/μL,P<0.0001).CONCLUSION:The relapse rate differed greatly between patients with complete and partial mucosal healing.A shift from complete to partial healing in clinically stable UC patients can be predicted by monitoring PLT.展开更多
AIM:To identify specific colonoscopic findings in patients with ulcerative colitis (UC) complicated by cyto-megalovirus (CMV) infection.METHODS: Among UC patients who were hospitalized due to exacerbation of symptoms,...AIM:To identify specific colonoscopic findings in patients with ulcerative colitis (UC) complicated by cyto-megalovirus (CMV) infection.METHODS: Among UC patients who were hospitalized due to exacerbation of symptoms, colonoscopic findings were compared between 15 CMV-positive patients and 58 CMV-negative patients. CMV infection was determined by blood test for CMV antigenemia. Five aspects of mucosal changes were analyzed (loss of vascular pattern, erythema, mucosal edema, easy bleeding, and mucinous exudates) as well as five aspects of ulcerative change (wide mucosal defect, punched-out ulceration, longitudinal ulceration, irregular ulceration, and cobble-stone-like appearance). Sensitivity, specificity, positive predictive value, and negative predictive value of each finding for CMV positivity were determined.RESULTS: The sensitivity of irregular ulceration for positive CMV was 100%. The specificity of wide mucosal defect was 95%. Punched-out ulceration and lon-gitudinal ulceration exhibited relatively high sensitivity and specificity (more than 70% for each).CONCLUSION:Specific colonoscopic findings in patients with UC complicated by CMV infection were identified. These findings may facilitate the early diagnosis of CMV infection in UC patients.展开更多
AIM: To clarify the effectiveness of CO2 insufflation in potentially difficult colonoscopy cases, particularly in relation to the experience level of colonoscopists.METHODS: One hundred twenty potentially difficult ca...AIM: To clarify the effectiveness of CO2 insufflation in potentially difficult colonoscopy cases, particularly in relation to the experience level of colonoscopists.METHODS: One hundred twenty potentially difficult cases were included in this study, which involved females with a low body mass index and patients with earlier abdominal and/or pelvic open surgery or previously diagnosed left-side colon diverticulosis. Patients receiving colonoscopy examinations without sedation using a pediatric variable-stiffness colonoscope were divided into two groups based on either CO2 or standard air insufflation. Both insufflation procedures were also evaluated according to the experience level of the respective colonoscopists who were divided into an experienced colonoscopist (EC) group and a less experienced colonoscopist (LEC) group. Study measurements included a 100-mm visual analogue scale (VAS) for patient pain during and after colonoscopyexaminations, in addition to insertion to the cecum and withdrawal times.RESULTS: Examination times did not differ, however, VAS scores in the CO2 group were signifi cantly better than in the air group (P < 0.001, two-way ANOVA) from immediately after the procedure and up to 2 h later. There were no significant differences between either insufflation method in the EC group (P = 0.29), however, VAS scores for CO2 insufflation were significantly better than air insufflation in the LEC group (P = 0.023) immediately after colonoscopies and up to 4 h afterwards.CONCLUSION: CO2 insufflation reduced patient pain after colonoscopy in potentially difficult cases when performed by LECs.展开更多
AIM: To assess the risk of relapse in ulcerative colitis(UC) patients in clinical remission using mucosal status and fecal immunochemical test(FIT) results. METHODS: The clinical outcomes of 194 UC patients in clinica...AIM: To assess the risk of relapse in ulcerative colitis(UC) patients in clinical remission using mucosal status and fecal immunochemical test(FIT) results. METHODS: The clinical outcomes of 194 UC patients in clinical remission who underwent colonoscopy were based on evaluations of Mayo endoscopic subscores(MESs) and FIT results.RESULTS: Patients with an MES of 0(n = 94, 48%) showed a ten-fold lower risk of relapse than those with an MES of 1-3(n = 100, 52%)(HR = 0.10, 95%CI: 0.05-0.19). A negative FIT result(fecal hemoglobin concentrations ≤ 100 ng/m L) was predictive of patients with an MES of 0, with a sensitivity of 0.94 and a specific of 0.76. Moreover, patients with a negative FIT score had a six-fold lower risk of clinical relapse than those with a positive score(HR = 0.17, 95%CI: 0.10-0.28). Inclusion of the distinguishing parameter, sustaining clinical remission > 12 mo, resulted in an even stronger correlation between negative FIT results and an MES of 0 with respect to the risk of clinical relapse(HR = 0.11, 95%CI: 0.04-0.23).CONCLUSION: Negative FIT results one year or more after remission induction correlate with complete mucosal healing(MES 0) and better prognosis. Performing FIT one year after remission induction may be useful for evaluating relapse risk.展开更多
AIM:To clarify the impact of cytomegalovirus(CMV)activation and antiviral therapy based on CMV antigen status on the long-term clinical course of ulcerative colitis(UC)patients.METHODS:UC patients with flare-up were d...AIM:To clarify the impact of cytomegalovirus(CMV)activation and antiviral therapy based on CMV antigen status on the long-term clinical course of ulcerative colitis(UC)patients.METHODS:UC patients with flare-up were divided into CMV-positive and-negative groups according to the CMV antigenemia assay.The main treatment strategy provided for the patients in the CMV-positive group comprised a dose reduction of corticosteroids and administration of ganciclovir.RESULTS:The median number of days to initial remission was significantly greater for the patients in the CMV-positive group(21 d vs 16 d,P=0.009).However,the relapse rate after remission and colectomy rate during more than 30 mo of observation did not differ between the two groups.Multivariate analysis revealed that administration of ganciclovir was the only independent factor for avoiding colectomy in patients of the CMV-positive group.CONCLUSION:CMV antigen status did not significantly affect the long-term prognosis in UC patients under treatment with appropriate antiviral therapy.展开更多
AIM:To examine the feasibility of predicting the flareup of ulcerative colitis (UC) before symptoms emerge using the immunochemical fecal occult blood test (IFOBT).METHODS:We prospectively measured fecal hemoglobin co...AIM:To examine the feasibility of predicting the flareup of ulcerative colitis (UC) before symptoms emerge using the immunochemical fecal occult blood test (IFOBT).METHODS:We prospectively measured fecal hemoglobin concentrations in 78 UC patients using the I-FOBT every 1 or 2 mo.RESULTS:During a 20 mo-period,823 fecal samples from 78 patients were submitted.The median concentration of fecal hemoglobin was 41 ng/mL (range:0-392 500 ng/mL).There were three types of patients with regard to the correlation between I-FOBT and patient symptoms;the synchronous transition type with symptoms (44 patients),the unrelated type withsymptoms (19 patients),and the flare-up predictive type (15 patients).In patients with the flare-up predictive type,the values of I-FOBT were generally low during the study period with stable symptoms.Two to four weeks before the flare-up of symptoms,the I-FOBT values were high.Thus,in these patients,I-FOBT could predict the flare-up before symptoms emerged.CONCLUSION:Flare-up could be predicted by I-FOBT in approximately 20% of UC patients.These results warrant periodical I-FOBT in UC patients.展开更多
AIM To compare the tolerability and quality of bowel cleansing between 2 L polyethylene glycol(PEG)and reduced-dose sodium phosphate(Na P)tablets as a preparation for colonoscopy.METHODS Two hundred patients were rand...AIM To compare the tolerability and quality of bowel cleansing between 2 L polyethylene glycol(PEG)and reduced-dose sodium phosphate(Na P)tablets as a preparation for colonoscopy.METHODS Two hundred patients were randomly assigned to the PEG or Na P groups at the same ratio.The Na P group patients took 30 tablets with 2 L of clear liquid,while the PEG group patients took 2L of PEG.Tolerability was assessed by a questionnaire about taste,volume,and the overall impression.The bowel cleansing quality was evaluated by colonoscopists.RESULTS Although Na P showed better tolerability in terms of taste,volume and overall impression(P<0.01,P<0.01 and P=0.02,respectively),the overall cleansing quality was better in the PEG group(P<0.01).A subgroup analysis,stratified by sex and age,indicated that Na P was associated with better tolerability and equivalent bowel cleansing quality in females of<50years of age.CONCLUSION Despite the better tolerability,the use of 30 Na P tablets with 2 L of clear liquid should be limited due to its lower cleansing quality;however,in certain cases the regimen may deserve consideration,particularly in cases involving young women.展开更多
Background: Although inflammatory bowel disease (IBD) patients have been increasing and new thera-peutic options for IBD have been developed, there are relatively few clinicians who specialize in IBD. Patients treated...Background: Although inflammatory bowel disease (IBD) patients have been increasing and new thera-peutic options for IBD have been developed, there are relatively few clinicians who specialize in IBD. Patients treated by a non-specialist of IBD may not receive appropriate treatment. This study aimed to compare disease and medication status between IBD patients treated by a specialist and those treated by a non-specialist. Methods: Medical charts of ambulating IBD patients in two hospitals were examined. All patients in one hospital were treated by one of the IBD specialists, while in the other hospital, patients were treated by one of the gastroenterologists who was a non-specialist of IBD. Results: The numbers of IBD patients were 255 (hospital with specialists) and 74 (hospital without specialists), respectively. Disease activity of the patients was not well-controlled in the hospital without specialists compared to in the hospi- tal with specialists (ulcerative colitis (UC): p = 0.0006 and Crohn’s disease: p = 0.012, respectively). The proportion of UC patients who received an insufficient dose of mesalazine (Pentasa < 3 g/day or Asacol < 3.6 g/day) was higher in the hospital without specialists (47% vs. 15%, p < 0.0001). In the hospital without specialists, more patients received long-term corticosteroids (UC: 23% vs. 5%, p < 0.0001), while fewer patients received immunomodulators (UC: 8% vs. 46%, p < 0.0001). Conclusions: IBD patients of the hospital without specialists were not well-controlled and were not prescribed appropriately with thera-peutic drugs. Fostering and placement of the specialist of IBD is an urgent problem.展开更多
文摘AIM:To determine the difference in clinical outcome between ulcerative colitis(UC)patients with Mayo endoscopic subscore(MES)0 and those with MES 1.METHODS:UC patients with sustained clinical remission of 6 mo or more at the time of colonoscopy were examined for clinical outcomes and the hazard ratios of clinical relapse according to MES.Parameters,including blood tests,to identify predictive factors for MES 0and slight endoscopic recurrence in clinically stablepatients were assessed.Moreover,a receiver operating characteristic curve was generated,and the area under the curve was calculated to indicate the utility of the parameters for the division between complete and partial mucosal healing.All P values were two-sided and considered significant when less than 0.05.RESULTS:A total of 183 patients with clinical remission were examined.Patients with MES 0(complete mucosal healing:n=80,44%)were much less likely to relapse than those with MES 1(partial mucosal healing:n=89,48%)(P<0.0001,log-rank test),and the hazard ratio of risk of relapse in patients with MES 1 vs MES0 was 8.17(95%CI:4.19-17.96,P<0.0001).The platelet count(PLT)<26×104/μL was an independent predictive factor for complete mucosal healing(OR=4.1,95%CI:2.15-7.99).Among patients with MES 0 at the initial colonoscopy,patients of whom colonoscopy findings shifted to MES 1 showed significant increases in PLT compared to those who maintained MES 0(3.8×104/μL vs-0.6×104/μL,P<0.0001).CONCLUSION:The relapse rate differed greatly between patients with complete and partial mucosal healing.A shift from complete to partial healing in clinically stable UC patients can be predicted by monitoring PLT.
文摘AIM:To identify specific colonoscopic findings in patients with ulcerative colitis (UC) complicated by cyto-megalovirus (CMV) infection.METHODS: Among UC patients who were hospitalized due to exacerbation of symptoms, colonoscopic findings were compared between 15 CMV-positive patients and 58 CMV-negative patients. CMV infection was determined by blood test for CMV antigenemia. Five aspects of mucosal changes were analyzed (loss of vascular pattern, erythema, mucosal edema, easy bleeding, and mucinous exudates) as well as five aspects of ulcerative change (wide mucosal defect, punched-out ulceration, longitudinal ulceration, irregular ulceration, and cobble-stone-like appearance). Sensitivity, specificity, positive predictive value, and negative predictive value of each finding for CMV positivity were determined.RESULTS: The sensitivity of irregular ulceration for positive CMV was 100%. The specificity of wide mucosal defect was 95%. Punched-out ulceration and lon-gitudinal ulceration exhibited relatively high sensitivity and specificity (more than 70% for each).CONCLUSION:Specific colonoscopic findings in patients with UC complicated by CMV infection were identified. These findings may facilitate the early diagnosis of CMV infection in UC patients.
基金Supported by The Japanese Foundation for Research and Promotion of Endoscopy (JFE)
文摘AIM: To clarify the effectiveness of CO2 insufflation in potentially difficult colonoscopy cases, particularly in relation to the experience level of colonoscopists.METHODS: One hundred twenty potentially difficult cases were included in this study, which involved females with a low body mass index and patients with earlier abdominal and/or pelvic open surgery or previously diagnosed left-side colon diverticulosis. Patients receiving colonoscopy examinations without sedation using a pediatric variable-stiffness colonoscope were divided into two groups based on either CO2 or standard air insufflation. Both insufflation procedures were also evaluated according to the experience level of the respective colonoscopists who were divided into an experienced colonoscopist (EC) group and a less experienced colonoscopist (LEC) group. Study measurements included a 100-mm visual analogue scale (VAS) for patient pain during and after colonoscopyexaminations, in addition to insertion to the cecum and withdrawal times.RESULTS: Examination times did not differ, however, VAS scores in the CO2 group were signifi cantly better than in the air group (P < 0.001, two-way ANOVA) from immediately after the procedure and up to 2 h later. There were no significant differences between either insufflation method in the EC group (P = 0.29), however, VAS scores for CO2 insufflation were significantly better than air insufflation in the LEC group (P = 0.023) immediately after colonoscopies and up to 4 h afterwards.CONCLUSION: CO2 insufflation reduced patient pain after colonoscopy in potentially difficult cases when performed by LECs.
文摘AIM: To assess the risk of relapse in ulcerative colitis(UC) patients in clinical remission using mucosal status and fecal immunochemical test(FIT) results. METHODS: The clinical outcomes of 194 UC patients in clinical remission who underwent colonoscopy were based on evaluations of Mayo endoscopic subscores(MESs) and FIT results.RESULTS: Patients with an MES of 0(n = 94, 48%) showed a ten-fold lower risk of relapse than those with an MES of 1-3(n = 100, 52%)(HR = 0.10, 95%CI: 0.05-0.19). A negative FIT result(fecal hemoglobin concentrations ≤ 100 ng/m L) was predictive of patients with an MES of 0, with a sensitivity of 0.94 and a specific of 0.76. Moreover, patients with a negative FIT score had a six-fold lower risk of clinical relapse than those with a positive score(HR = 0.17, 95%CI: 0.10-0.28). Inclusion of the distinguishing parameter, sustaining clinical remission > 12 mo, resulted in an even stronger correlation between negative FIT results and an MES of 0 with respect to the risk of clinical relapse(HR = 0.11, 95%CI: 0.04-0.23).CONCLUSION: Negative FIT results one year or more after remission induction correlate with complete mucosal healing(MES 0) and better prognosis. Performing FIT one year after remission induction may be useful for evaluating relapse risk.
文摘AIM:To clarify the impact of cytomegalovirus(CMV)activation and antiviral therapy based on CMV antigen status on the long-term clinical course of ulcerative colitis(UC)patients.METHODS:UC patients with flare-up were divided into CMV-positive and-negative groups according to the CMV antigenemia assay.The main treatment strategy provided for the patients in the CMV-positive group comprised a dose reduction of corticosteroids and administration of ganciclovir.RESULTS:The median number of days to initial remission was significantly greater for the patients in the CMV-positive group(21 d vs 16 d,P=0.009).However,the relapse rate after remission and colectomy rate during more than 30 mo of observation did not differ between the two groups.Multivariate analysis revealed that administration of ganciclovir was the only independent factor for avoiding colectomy in patients of the CMV-positive group.CONCLUSION:CMV antigen status did not significantly affect the long-term prognosis in UC patients under treatment with appropriate antiviral therapy.
文摘AIM:To examine the feasibility of predicting the flareup of ulcerative colitis (UC) before symptoms emerge using the immunochemical fecal occult blood test (IFOBT).METHODS:We prospectively measured fecal hemoglobin concentrations in 78 UC patients using the I-FOBT every 1 or 2 mo.RESULTS:During a 20 mo-period,823 fecal samples from 78 patients were submitted.The median concentration of fecal hemoglobin was 41 ng/mL (range:0-392 500 ng/mL).There were three types of patients with regard to the correlation between I-FOBT and patient symptoms;the synchronous transition type with symptoms (44 patients),the unrelated type withsymptoms (19 patients),and the flare-up predictive type (15 patients).In patients with the flare-up predictive type,the values of I-FOBT were generally low during the study period with stable symptoms.Two to four weeks before the flare-up of symptoms,the I-FOBT values were high.Thus,in these patients,I-FOBT could predict the flare-up before symptoms emerged.CONCLUSION:Flare-up could be predicted by I-FOBT in approximately 20% of UC patients.These results warrant periodical I-FOBT in UC patients.
文摘AIM To compare the tolerability and quality of bowel cleansing between 2 L polyethylene glycol(PEG)and reduced-dose sodium phosphate(Na P)tablets as a preparation for colonoscopy.METHODS Two hundred patients were randomly assigned to the PEG or Na P groups at the same ratio.The Na P group patients took 30 tablets with 2 L of clear liquid,while the PEG group patients took 2L of PEG.Tolerability was assessed by a questionnaire about taste,volume,and the overall impression.The bowel cleansing quality was evaluated by colonoscopists.RESULTS Although Na P showed better tolerability in terms of taste,volume and overall impression(P<0.01,P<0.01 and P=0.02,respectively),the overall cleansing quality was better in the PEG group(P<0.01).A subgroup analysis,stratified by sex and age,indicated that Na P was associated with better tolerability and equivalent bowel cleansing quality in females of<50years of age.CONCLUSION Despite the better tolerability,the use of 30 Na P tablets with 2 L of clear liquid should be limited due to its lower cleansing quality;however,in certain cases the regimen may deserve consideration,particularly in cases involving young women.
文摘Background: Although inflammatory bowel disease (IBD) patients have been increasing and new thera-peutic options for IBD have been developed, there are relatively few clinicians who specialize in IBD. Patients treated by a non-specialist of IBD may not receive appropriate treatment. This study aimed to compare disease and medication status between IBD patients treated by a specialist and those treated by a non-specialist. Methods: Medical charts of ambulating IBD patients in two hospitals were examined. All patients in one hospital were treated by one of the IBD specialists, while in the other hospital, patients were treated by one of the gastroenterologists who was a non-specialist of IBD. Results: The numbers of IBD patients were 255 (hospital with specialists) and 74 (hospital without specialists), respectively. Disease activity of the patients was not well-controlled in the hospital without specialists compared to in the hospi- tal with specialists (ulcerative colitis (UC): p = 0.0006 and Crohn’s disease: p = 0.012, respectively). The proportion of UC patients who received an insufficient dose of mesalazine (Pentasa < 3 g/day or Asacol < 3.6 g/day) was higher in the hospital without specialists (47% vs. 15%, p < 0.0001). In the hospital without specialists, more patients received long-term corticosteroids (UC: 23% vs. 5%, p < 0.0001), while fewer patients received immunomodulators (UC: 8% vs. 46%, p < 0.0001). Conclusions: IBD patients of the hospital without specialists were not well-controlled and were not prescribed appropriately with thera-peutic drugs. Fostering and placement of the specialist of IBD is an urgent problem.
