Faculty Profiles - NAKAMURA, Masanao

Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J00192&link_issn=&doc_id=20240405340006&doc_link_id=10.11280%2Fgee.66.279&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.66.279&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

ESDで診断に至った深在性嚢胞性大腸炎の1例

山田健太朗, 山村健史, 中村正直, 前田啓子, 澤田つな騎, 石川恵里, 梶川豪, 長谷川一成, 横井太紀雄, 川嶋啓揮

Gastroenterological Endoscopy Vol. 66 ( 3 ) page： 279 - 285 2024.3

Language：Japanese Publisher：(一社)日本消化器内視鏡学会

症例は46歳,女性.他院でのCSで直腸腫瘤を認めたため精査目的に紹介となった.当院で施行したCSでは直腸に10mm大の粘膜下腫瘍様隆起を認め,EUSで第3層を主座とする輪郭明瞭な10mm大の低エコー腫瘍として描出された.ボーリング生検を施行するも確定診断には至らなかったこと,EUSで粘膜下層までに局在する腫瘍と考えられたことから,診断的治療目的にESDを施行した.病理組織学的検査で深在性嚢胞性大腸炎の診断を得た.(著者抄録)

最先端医療の今潰瘍性大腸炎患者の腸粘液解析

中村正直, 山村健史, 前田啓子, 澤田つな騎, 石川恵里, 村手健太郎, 川嶋啓揮

Medical Science Digest Vol. 50 ( 3 ) page： 156 - 157 2024.3

Language：Japanese Publisher：(株)ニュー・サイエンス社

潰瘍性大腸炎(UC)の発症は,慢性の精神ストレスが腸粘膜内の神経-免疫系に影響し,粘膜神経系因子の不安定さと食事が影響した粘液バリアの破綻が重なった際に起こり得る粘膜固有層内免疫細胞の過剰応答,上皮バリア破綻,腸内環境との過剰コンタクトが一因と考えられる。臨床的にはベースに食事変化による腸粘液粘膜バリアの脆弱化があるなかで,メンタルストレスの変動によりその閾値を越えたときに目にみえて症状が現れるのがひとつのルートと考える。この分野において今までは粘膜を材料とした研究に限られていた。筆者らは大腸内視鏡時に,生検組織に加え同部位でのブラシ鉗子による腸粘液採取も行った。寛解時と再燃時で神経系因子を含めた各検出因子発現変化量,免疫細胞,サイトカイン量,蛋白質分布を比較している。粘膜粘液炎症機序相関図を作成,炎症の根源で治療ターゲットとなるキーファクターを同定することができればUC原因機序解明の新たな一歩となり得る。(著者抄録)

【IBD診療-ますます増えた薬剤の選択とさらなる進化の展望】治療薬の使い分けの総論と各論中等症UCにおけるバイオ製剤/JAK阻害薬の使い分け-抗IL-23抗体も含めて

中村正直, 山村健史, 前田啓子, 澤田つな騎, 石川恵里, 川嶋啓揮

臨床消化器内科 Vol. 39 ( 2 ) page： 140 - 146 2024.1

Language：Japanese Publisher：(株)日本メディカルセンター

＜文献概要＞中等症の潰瘍性大腸炎(UC)患者に対する治療の現状においては,とくにステロイド依存例,抵抗例となった難治例への治療薬が多く導入されたことで治療効果の底上げがなされたと考えられる.一方,実際の臨床現場においては適切な治療選択が求められる.現在難治例には9種の薬剤が使用され,作用機序面から抗TNF-α抗体製剤,Non TNF-α抗体製剤,低分子化合物の3タイプに分けた.初めてのバイオ製剤/JAK阻害薬選択方法の一案として,(1)臨床的活動性が軽症に近いか,重症寄りか,(2)使用薬剤における禁忌の回避,(3)利便性,受容性を考えている.バイオ製剤/JAK阻害薬の切り換えは,前治療の治療効果と作用機序も考慮して薬剤選択に臨む必要がある.

小腸疾患治療の最前線腸リンパ管拡張症の臨床的・内視鏡的特徴と治療法の検討

山下彩子, 中村正直, 山村健史, 前田啓子, 澤田つな騎, 石川恵里, 村手健太郎, 廣瀬崇, 古川和宏, 川嶋啓揮

日本消化管学会雑誌 Vol. 8 ( Suppl. ) page： 208 - 208 2024.1

Long-term monitoring and clinical implications of small bowel capsule endoscopy in patients with Crohn's disease with small bowel lesions: A Retrospective Analysis. International journal

Masanao Nakamura, Takeshi Yamamura, Keiko Maeda, Tsunaki Sawada, Eri Ishikawa, Kentaro Murate, Kazuhiro Furukawa, Takashi Hirose, Kota Uetsuki, Tadashi Iida, Yasuyuki Mizutani, Kentaro Yamao, Yoji Ishizu, Takuya Ishikawa, Takashi Honda, Hiroki Kawashima

Digestion Vol. 105 ( 5 ) page： 380 - 388 2024

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Crohn's disease (CD) induces persistent inflammation throughout the gastrointestinal (GI) tract, potentially resulting in complications such as intestinal stenosis and fistulas, particularly in the small bowel. Small-bowel capsule endoscopy (SBCE) is recommended for monitoring CD, especially when GI tract patency is maintained. This study aimed to retrospectively assess patients with CD who underwent SBCE to determine the timing of clinical changes and address the current lack of evidence regarding GI tract patency loss during CD treatment. METHODS: Of the 166 consecutive patients who underwent SBCE at our institution, 120 were followed up and included in this study. Forty-six patients were excluded due to colitis type or immediate treatment changes post-SBCE. This study focused on the primary and secondary endpoints, including the cumulative stricture-free rate of the GI tract, emergency hospitalization post-SBCE, and post-SBCE treatment strategies, at the discretion of the attending physicians. RESULTS: Demographic data revealed that the mean age of the study population was 43 years and that there was a male predominance (75%). The median disease duration was 12 years and the mean Crohn's Disease Activity Index was 98. During a 1,486-day observation period, 37% of patients experienced treatment changes. A Lewis score of >264 and perianal lesions were identified as independent risk factors for additional treatment needs. Emergency hospitalization occurred in 6% of patients and GI patency failure in 11%. Female sex and Lewis score>264 were associated with higher risks. GI patency rate declined two years after SBCE. CONCLUSIONS: For patients who experienced no treatment changes based on SBCE results, it is recommended to undergo SBCE monitoring at intervals of no longer than two years.

DOI： 10.1159/000539745

Initial Tumor Size and Narrow-Band Image Findings Estimate Growth Speed in Duodenal Tumors. International journal

Takashi Hirose, Naomi Kakushima, Yoshiyuki Minami, Satoshi Furune, Eri Ishikawa, Tsunaki Sawada, Keiko Maeda, Takeshi Yamamura, Kazuhiro Furukawa, Masanao Nakamura, Masato Nakaguro, Hiroki Kawashima

Digestive diseases (Basel, Switzerland) Vol. 42 ( 6 ) page： 512 - 521 2024

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Recently, the detection of superficial non-ampullary duodenal epithelial tumors (SNADETs) including adenomas and superficial duodenal carcinomas has increased. Various endoscopic treatment methods have also been reported for SNADETs, but there are few reports on the natural history. The aim of this study was to analyze factors related to tumor growth and determine the characteristics of SNADETs which need early therapeutic intervention. METHODS: A single-center, retrospective study was performed on the medical records of 309 patients with SNADETs who underwent endoscopic or surgical resection between January 2010 and May 2021. Of these, 41 patients who were followed up for more than 1 year by endoscopy were analyzed. The primary outcome was an analysis of the tumor growth speed. Secondary outcomes were the relationship between the tumor growth speed and mucin phenotype, tumor size and findings of magnifying endoscopy with narrow-band imaging (M-NBI). RESULTS: The observation period was 24 months (13-182). Tumor growth speed was 1.1 mm/year (0-21.6). Tumor diameter ≥10 mm at first detection (p = 0.004; odds ratio 19.5 [2.03-186.96]) and mixed type by M-NBI (p = 0.036; odds ratio 9.69 [1.05-89.88]) were identified as risk factors of tumors growing at a rate of ≥3 mm/year. There was no statistically significant difference in the speed of tumor growth between the different mucin immunohistochemical phenotypes. CONCLUSION: Initial tumor size and findings of M-NBI are useful to predict tumor growth and consider early intervention.

DOI： 10.1159/000540544

Analysis of Neuropeptides in the Intestinal Mucus of Patients with Ulcerative Colitis Using RNA Sequencing. International journal

Masanao Nakamura, Kentaro Murate, Keiko Maeda, Takeshi Yamamura, Tsunaki Sawada, Eri Ishikawa, Kazuhiro Furukawa, Takashi Hirose, Kota Uetsuki, Tadashi Iida, Yasuyuki Mizutani, Kentaro Yamao, Yoji Ishizu, Takuya Ishikawa, Takashi Honda, Hiroki Kawashima

Digestion Vol. 105 ( 5 ) page： 400 - 410 2024

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Inflammation in ulcerative colitis (UC) originates in the colorectal mucosa. Transcriptome sequencing analysis of the colorectal mucosa allows the identification of potential neuropeptides related to local neurotransmission. The intestinal mucus lining the surface of the mucosa may harbor biomarkers of mucosal inflammation; however, this has not been sufficiently investigated, given the difficulty in obtaining human samples. We previously reported the feasibility of obtaining mucin samples for proteomic analysis by brushing during colonoscopy. Herein, we aimed to investigate the composition of the intestinal mucus and detect neuropeptides characteristic of UC. METHODS: Mucus and mucosal samples were collected from patients with UC from the colorectum in areas showing remission or active UC using a brush catheter and biopsy forceps during colonoscopy. RNA sequencing findings of mucus samples of active and remission areas were compared. RNA and protein expression levels of significantly upregulated neuropeptides were analyzed. RESULTS: Of the neuropeptides associated with UC, somatostatin (SST) was significantly elevated in areas of remission, according to RNA sequencing results of mucus and expression levels in mucus RNA and proteins. Conversely, SST expression in the mucosa was increased in the inflamed areas. Flow cytometry revealed that the fluorescence intensity of SST-positive cells in the remission zone was higher in the mucus than in the mucosa. CONCLUSION: SST expression in the mucus is considered to be an important factor associated with UC activity.

DOI： 10.1159/000540052

腸内微生物叢からみた消化器疾患の病態解明腸管上皮細胞の腸内細菌叢に対する認識機構の解明と炎症性腸疾患における機能解析

大腸ポリープに対するCold snare polypectomyで腹腔内出血をきたした1例

池上脩二, 山村健史, 中村正直, 前田啓子, 澤田つな騎, 石川恵里, 古川和宏, 石川卓哉, 山雄健太郎, 水谷泰之, 飯田忠, 植月康太, 廣瀬崇, 横井太紀雄, 川嶋啓揮

日本消化器内視鏡学会東海支部例会 Vol. 66回 page： 113 - 113 2023.12

前田啓子, 中村正直, 川嶋啓揮

日本消化器病学会雑誌 Vol. 120 ( 臨増大会 ) page： A716 - A716 2023.10

Risk factors for rebleeding in gastroduodenal ulcers. International journal

Nobuhito Ito, Kohei Funasaka, Toshihisa Fujiyoshi, Kazuki Nishida, Yusuke Satta, Kazuhiro Furukawa, Naomi Kakushima, Satoshi Furune, Eri Ishikawa, Yasuyuki Mizutani, Tsunaki Sawada, Keiko Maeda, Takuya Ishikawa, Takeshi Yamamura, Eizaburo Ohno, Masanao Nakamura, Ryoji Miyahara, Yoji Sasaki, Jun-Ichi Haruta, Mitsuhiro Fujishiro, Hiroki Kawashima

Irish journal of medical science 2023.7

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Rebleeding after hemostasis of the gastroduodenal ulcer (GDU) is one of the indicators associated with death among GDU patients. However, there are few studies on risk score that contribute to rebleeding after endoscopic hemostasis of bleeding peptic ulcers. AIMS: The aim of this study was to identify factors associated with rebleeding, including patient factors, after endoscopic hemostasis of bleeding gastroduodenal ulcers and to stratify the risk of rebleeding. METHODS: We retrospectively enrolled 587 consecutive patients who were treated for Forrest Ia to IIa bleeding gastroduodenal ulcers with endoscopic hemostasis at three institutions. Risk factors associated with rebleeding were assessed using univariate and multivariate logistic regression analyses. The Rebleeding Nagoya University (Rebleeding-N) scoring system was developed based on the extracted factors. The Rebleeding-N score was internally validated using bootstrap resampling methods. RESULTS: Sixty-four patients (11%) had rebleeding after hemostasis of gastroduodenal ulcers. Multivariate logistic regression analysis revealed four independent rebleeding risk factors: blood transfusion, albumin <2.5, duodenal ulcer, and diameter of the exposed vessel ≧2 mm. Patients with 4 risk factors in the Rebleeding-N score had a 54% rebleeding rate, and patients with 3 risk factors had 44% and 25% rebleeding rates. In the internal validation, the mean area under the curve of the Rebleeding-N score was 0.830 (95% CI = 0.786-0.870). CONCLUSIONS: Rebleeding after clip hemostasis of bleeding gastroduodenal ulcers was associated with blood transfusion, albumin <2.5, diameter of the exposed vessel ≧2 mm, and duodenal ulcer. The Rebleeding-N score was able to stratify the risk of rebleeding.

DOI： 10.1007/s11845-023-03450-2

Randomized trial comparing 15 vs 5 actuations per pass during endoscopic ultrasound-guided fine-needle biopsy for specimen acquisition of solid pancreatic lesions. International journal

Kunio Kataoka, Takuya Ishikawa, Eizaburo Ohno, Kentaro Yamao, Yasuyuki Mizutani, Tadashi Iida, Katsuyuki Kato, Fumie Kinoshita, Takeshi Yamamura, Kazuhiro Furukawa, Masanao Nakamura, Hiroki Kawashima

Journal of gastroenterology and hepatology Vol. 38 ( 9 ) page： 1647 - 1655 2023.6

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND AND AIM: There is currently no established number of actuations (to-and-fro movements) per pass during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). This study aimed to compare 15 vs 5 actuations in terms of adequate specimen acquisition of solid pancreatic lesions. METHODS: In this prospective, randomized, crossover, noninferiority, single-center study, eligible patients underwent EUS-FNB using a 22-G Franseen needle with both 15 and 5 actuations per pass, performed in a randomized order, from October 2020 to December 2021. The acquired specimens from each pass were separately evaluated. The primary outcome was the accuracy of the histological diagnosis per pass. The noninferiority margin was set as 15%. RESULTS: Data from 85 patients were analyzed, revealing pancreatic cancer in 73 patients. The accuracy of the histological diagnosis in the 15 and 5 actuations groups was 83.5% (71/85) and 77.7% (66/85), respectively. The difference was -5.8% (95% confidence interval -15.6-3.4), which does not indicate noninferiority of the five actuations group. Among the secondary outcomes, the 15 actuations group was significantly superior to the five actuations group in terms of the obtained core tissues (1.88 [interquartile range 0.89-3.64] mm2 vs 1.66 [0.83-2.71] mm2 [P = 0.031]) and subjective evaluation of cytology specimens for pancreatic cancer (69.0% vs. 31.0%, P = 0.005). CONCLUSIONS: The noninferiority of five actuations in the accuracy of the histological diagnosis was not confirmed, and 15 actuations are preferred during EUS-FNB for solid pancreatic lesions.

DOI： 10.1111/jgh.16258

Diagnostic Performance of Endocytoscopy for Esophageal Eosinophilia. International journal

Emiko Hida, Koichi Muroi, Naomi Kakushima, Satoshi Furune, Eri Ishikawa, Yasuyuki Mizutani, Tsunaki Sawada, Maeda Keiko, Takeshi Yamamura, Takuya Ishikawa, Kazuhiro Furukawa, Eizaburo Ohno, Masanao Nakamura, Kazuki Nishida, Mitsuhiro Fujishiro, Hiroki Kawashima

Digestion Vol. 104 ( 3 ) page： 202 - 211 2023.6

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Eosinophils in the esophageal epithelium are unevenly distributed in eosinophilic esophagitis (EoE). Esophageal eosinophilia (EE) may be observable by endocytoscopy (EC). This study aimed to evaluate the diagnostic performance of EC for the diagnosis of EE. METHODS: A total of 33 EoE patients underwent EC with methylene blue staining from March 2020 to April 2021. A total of 194 EC images with corresponding biopsies were obtained. Three findings of EC, increased squamous cells (item I), increased inflammatory cells (item II), and cells with bilobed nuclei (item III), were established. These findings were reviewed by two endoscopists to diagnose EE. Another four endoscopists reviewed the images for interobserver agreement. RESULTS: When all three items were met by EC, the sensitivity and the accuracy for the diagnosis of EE were 88% and 76%, respectively. The integrated diagnostic odds ratios (ORs) for the diagnosis of EE of the four endoscopists were significant (OR: 3.98, 95% CI: 2.94-5.40, p < 0.001). The results were similar when only item III was met. Interobserver agreement was good for item III to diagnose EE (kappa value = 0.653). DISCUSSION/CONCLUSION: The diagnostic performance of EC for EE is acceptable and has good interobserver agreement. It may be useful for targeted biopsy in EoE patients.

DOI： 10.1159/000528174

Modified Nスコアは,吐血を伴わない黒色便患者において内視鏡的止血処置が必要な患者を予測するのに有用である

伊藤信仁, 舩坂好平, 藤吉俊尚, 古川和宏, 角嶋直美, 古根聡, 石川恵里, 水谷泰之, 澤田つな騎, 前田啓子, 石川卓哉, 山村健史, 大野栄三郎, 中村正直, 川嶋啓揮, 宮原良二, 廣岡芳樹, 春田純一, 藤城光弘

Gastroenterological Endoscopy Vol. 65 ( 6 ) page： 1165 - 1174 2023.6

Language：Japanese Publisher：(一社)日本消化器内視鏡学会

【目的】黒色便は上部消化管出血を疑う症状の1つであるが,吐血を伴わない黒色便患者のすべてに内視鏡的止血処置を必要とするわけではない.これまでに内視鏡的止血処置が必要な患者を予測するための明らかな指標は報告されていない.本研究の目的は,吐血を伴わない黒色便患者において,内視鏡的止血処置が必要な患者を予測する新規のスコアを確立することである.【方法】われわれは,2施設において,吐血を伴わない黒色便を主訴として緊急内視鏡検査を行った連続721例の患者をレトロスペクティブに登録した.開発コホート(2016年1月～2018年12月)422例の患者データから内視鏡的止血処置が必要な患者を予測するリスク因子を多変量ロジスティック回帰分析により決定し,modified Nagoya University score(modified Nスコア)と名付けた新規スコアリングシステムを作成した.検証コホート(2019年1月～2020年12月)299名の患者データを用いmodified Nスコアの診断能について評価した.【結果】ロジスティック回帰分析による多変量解析により,内視鏡的止血処置が必要な患者を予測する因子として,失神,血中BUN値,BUN/クレアチニン比が正の予測因子として,抗凝固薬内服が負の予測因子として,計4因子が抽出された.検証コホートにおいてmodified NスコアのROC曲線によるAUCは0.731であり,modified Nスコアの内視鏡的止血処置予測感度は82.0%,特異度は58.8%であった.【結論】4因子からなるmodified Nスコアは,吐血を伴わない黒色便患者において内視鏡的止血処置を必要とする患者を予測することができる.(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00192&link_issn=&doc_id=20230629350011&doc_link_id=10.11280%2Fgee.65.1165&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.65.1165&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

膵腫瘍(嚢胞性疾患も)の超音波およびEUS診断膵腫瘍に対するEUS-FNBにおける実体顕微鏡および精密電子天秤による検体量評価

石川卓哉, 山雄健太郎, 植月康太, 宜保憲明, 森裕, 本多隆, 中村正直, 石津洋二, 山本健太, 川嶋啓揮

超音波医学 Vol. 50 ( Suppl. ) page： S232 - S232 2023.4

超音波による膵実質評価と病態との関連性体外式超音波検査による腹臥位での膵尾部描出能の検討

熊野良平, 石川卓哉, 山雄健太郎, 植月康太, 宜保憲明, 本多隆, 中村正直, 石津洋二, 山本健太, 川嶋啓揮

超音波医学 Vol. 50 ( Suppl. ) page： S240 - S240 2023.4

がんゲノム医療における超音波の役割 EUS-FNA検体でMSI-Highと判定しPembrolizumabにより長期生存を得ている膵体部癌の一例

石川卓哉, 山雄健太郎, 植月康太, 宜保憲明, 森裕, 本多隆, 中村正直, 石津洋二, 山本健太, 川嶋啓揮

超音波医学 Vol. 50 ( Suppl. ) page： S177 - S177 2023.4

血友病患者における上部消化管内視鏡的止血術の検討

武藤久哲, 今井則博, 水野史崇, 松田宣賢, 犬飼庸介, 山本崇文, 水野和幸, 横山晋也, 山本健太, 伊藤隆徳, 石津洋二, 本多隆, 古川和宏, 中村正直, 石上雅敏, 川嶋啓揮

Gastroenterological Endoscopy Vol. 65 ( Suppl.1 ) page： 942 - 942 2023.4

Accuracy of Serum Leucine-Rich Alpha-2 Glycoprotein in Evaluating Endoscopic Disease Activity in Crohn's Disease. International journal

Tatsuya Kawamura, Takeshi Yamamura, Masanao Nakamura, Keiko Maeda, Tsunaki Sawada, Eri Ishikawa, Tadashi Iida, Yasuyuki Mizutani, Takuya Ishikawa, Naomi Kakushima, Kazuhiro Furukawa, Eizaburo Ohno, Takashi Honda, Hiroki Kawashima, Masatoshi Ishigami

Inflammatory bowel diseases Vol. 29 ( 2 ) page： 245 - 253 2023.2

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Mucosal healing, confirmed by endoscopic evaluation, is the long-term goal of treatment for Crohn's disease (CD). Leucine-rich alpha-2 glycoprotein (LRG) is a new serum biomarker correlated with disease activity in inflammatory bowel disease. However, studies evaluating its relationship with CD, particularly in the context of small intestinal lesions, are scarce. The aim of this study was to investigate the accuracy of LRG in assessing endoscopic activity, especially remission, in patients with CD. METHODS: Between July 2020 and March 2021, 72 patients with CD who underwent LRG testing and double-balloon endoscopy at the same time were included. Endoscopic activity was evaluated using the applied Simple Endoscopic Score for Crohn's disease, including small intestine lesions. The relationship of LRG with clinical symptoms and endoscopic activity was assessed, and its predictive accuracy was evaluated. RESULTS: Leucine-rich alpha-2 glycoprotein showed a significant positive correlation with endoscopic activity (r = 0.619, P < .001), even in patients with active lesions in the small intestine (r = 0.626, P < .001). Multivariate logistic regression revealed that LRG was the only factor associated with endoscopic remission. An LRG cutoff value of 8.9 μg/mL had a sensitivity of 93.3%; specificity of 83.3%; positive predictive value of 96.6%; negative predictive value of 71.4%; accuracy of 91.7%; and area under the curve of 0.904 for the prediction of endoscopic remission. CONCLUSIONS: Leucine-rich alpha-2 glycoprotein can be used in assessing endoscopic activity and is a reliable marker of endoscopic remission in CD patients. It can be an intermediate target in the treatment of CD.

DOI： 10.1093/ibd/izac076

Efficacy of 1-kestose supplementation in patients with mild to moderate ulcerative colitis: A randomised, double-blind, placebo-controlled pilot study. International journal

Shuji Ikegami, Masanao Nakamura, Takashi Honda, Takeshi Yamamura, Keiko Maeda, Tsunaki Sawada, Eri Ishikawa, Kenta Yamamoto, Satoshi Furune, Takuya Ishikawa, Kazuhiro Furukawa, Eizaburo Ohno, Masatoshi Ishigami, Fumie Kinoshita, Yoshihiro Kadota, Takumi Tochio, Yoshiharu Shimomura, Yoshiki Hirooka, Hiroki Kawashima

Alimentary pharmacology & therapeutics Vol. 57 ( 11 ) page： 1249 - 1257 2023.1

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Ulcerative colitis involves an excessive immune response to intestinal bacteria. Whether administering prebiotic 1-kestose is effective for active ulcerative colitis remains controversial. AIMS: This randomised, double-blind, placebo-controlled pilot trial investigated the efficacy of 1-kestose against active ulcerative colitis. METHODS: Forty patients with mild to moderate active ulcerative colitis were randomly treated with 1-kestose (N = 20) or placebo (maltose, N = 20) orally for 8 weeks in addition to the standard treatment. The Lichtiger clinical activity index and Ulcerative Colitis Endoscopic Index of Severity were determined. Faecal samples were analysed to evaluate the gut microbiome and metabolites. RESULTS: The clinical activity index at week 8 was significantly lower in the 1-kestose group than in the placebo group (3.8 ± 2.7 vs. 5.6 ± 2.1, p = 0.026). Clinical remission and response rates were higher in the 1-kestose group than in the placebo group (remission: 55% vs. 20%, p = 0.048; response: 60% vs. 25%, p = 0.054). The Ulcerative Colitis Endoscopic Index of Severity at week 8 was not significantly different (2.8 ± 1.6 vs. 3.5 ± 1.6, p = 0.145). Faecal analysis showed significantly reduced alpha-diversity in the 1-kestose group, with a decreased relative abundance of several bacteria, including Ruminococcus gnavus group. The short-chain fatty acid levels were not significantly different between the groups. The incidence of adverse events was comparable between the groups. DISCUSSION: Oral 1-kestose is well tolerated and provides clinical improvement for patients with mild to moderate ulcerative colitis through modulation of the gut microbiome.

DOI： 10.1111/apt.17387