研究者詳細 - 中村　正直

Clinical significance of gastrointestinal patency evaluation by using patency capsule in Crohn's disease

Yoshimura Toru, Hirooka Yoshiki, Nakamura Masanao, Watanabe Osamu, Yamamura Takeshi, Matsushita Masanobu, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Goto Hidemi

NAGOYA JOURNAL OF MEDICAL SCIENCE 80 巻 ( 1 ) 頁： 121 - 128 2018年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Nagoya Journal of Medical Science

Capsule endoscopy (CE) enables noninvasive visualization of the small bowel in Crohn's disease (CD), but should not be conducted in patients with bowel obstruction. Patency capsule (PC) can be ingested before conducting the CE examination to ensure patency of the gastrointestinal (GI) tract. This study aimed to evaluate the clinical significance of GI patency which the PC demonstrated. A retrospective review of the medical records was conducted with 99 consecutive patients with CD who underwent PC and CE at Nagoya University Hospital from January 2010 to May 2015. By using the Cox proportional hazards model, the association between the GI patency evaluated using the PC and the outcome in terms of the rate of patients who needed admission or surgery during the 2-year follow-up was examined. Of all 99 patients who ingested the PC, 84 (84.8%) were diagnosed as not having bowel obstruction, and therefore were eligible for CE (P group). Of the 15 patients in whom bowel obstruction was suspected (NP group), 12 patients underwent either the balloon-assisted endoscopy (n=10) or enteroclysis (n=2), and 11 were confirmed to have small bowel stricture. Non-admission rates of the P and NP groups during the 2-year observation period were 74/84 (88.0%) and 8/15 (53.3%), respectively (P<0.001). Non-operation rates of the P and NP groups during the 2-year observation period were 80/84 (95.2%) and 9/15 (60.0%), respectively (P<0.001). In conclusion, GI patency as diagnosed using the PC was associated with a significantly lower incidence of admission or surgical intervention.

DOI： 10.18999/nagjms.80.1.121

Functional Correlation Between the Pancreas and the Small Intestine in Humans: The First Evaluation Using a Newly Developed Enteroscopy 査読有り

Multiple keratotic papules and plaques on the trunk in Cowden's disease with MALT lymphoma 査読有り国際誌

Mizuno Sayaka, Takeichi Takuya, Sato Junichi, Nakamura Masanao, Goto Hidemi, Sugiura Kazumitsu, Akiyama Masashi

JOURNAL OF DERMATOLOGY 45 巻 ( 2 ) 頁： 238 - 240 2018年2月

Associations between drugs and small-bowel mucosal bleeding: Multicenter capsule-endoscopy study 査読有り

Niikura Ryota, Yamada Atsuo, Maki Koutarou, Nakamura Masanao, Watabe Hirotsugu, Fujishiro Mitsuhiro, Oka Shiro, Esaki Motohiro, Fujimori Shunji, Nakajima Atsushi, Ohmiya Naoki, Matsumoto Takayuki, Tanaka Shinji, Koike Kazuhiko, Sakamoto Choitsu

DIGESTIVE ENDOSCOPY 30 巻 ( 1 ) 頁： 79 - 89 2018年1月

記述言語：英語出版者・発行元：Digestive Endoscopy

Background and Aim: Although several drugs may induce small-bowel mucosal injuries, it is unclear whether these injuries contribute to overt small-bowel bleeding. This study was designed to evaluate the associations between drug use and small-bowel mucosal injury and between these mucosal injuries and overt bleeding in a disease-relevant population. Methods: We retrospectively studied patients with suspected small-bowel diseases who underwent capsule endoscopy between 2010 and 2013. Drug exposure, Charlson Comorbidity Index, smoking, and alcohol consumption were assessed before capsule endoscopy. Adjusted odds ratios (AOR) and confidence intervals (CI) were estimated for small-bowel mucosal injury and small-bowel overt bleeding. Results: In total, 850 patients were analyzed during the study period. Median age was 64 years, and 544 patients (64.0%) were men. Among the patients with small-bowel mucosal injury (n = 60) and without mucosal injury (n = 705), use of non-steroidal anti-inflammatory drugs (NSAIDs) (AOR 1.8, 95% CI 1.01–3.31) was significantly associated with an increased risk of small-bowel mucosal injury compared with non-use. Patients with small-bowel mucosal injury with overt bleeding (n = 85) and without overt bleeding (n = 60) were compared, and no significant difference between the groups in the usage rates for NSAIDs, thienopyridine, other antiplatelets, anticoagulants, acetaminophen, tramadol hydrochloride, or steroids was revealed, even after adjusting for confounders. Conclusion: Although the use of NSAIDs was significantly associated with an increased risk of small-bowel mucosal injury, no significant associations were observed between the use of such drugs and small-bowel overt bleeding.

DOI： 10.1111/den.12922

Hayashi Daijuro, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Kuwahara Takamichi, Kawai Manabu, Yamamura Takeshi, Furukawa Kazuhiro, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Ishigami Masatoshi, Hashimoto Senju, Goto Hidemi

PANCREAS 47 巻 ( 5 ) 頁： 601 - 608 2018年

出版者・発行元：Pancreas

Objectives: The aim of this study is to evaluate a functional correlation between the pancreas and the small intestine and the association of this relationship with nutritional status, using magnifying enteroscopy. Methods: The subjects were adults aged 20 years or older who underwent upper gastrointestinal endoscopy. An endoscope was inserted into the jejunum, and 10% glucose was sprayed under magnifying observation to evaluate changes in blood flow in the villous capillary network. Mucosal biopsy was performed before and after spraying to evaluate the incretin response in the jejunal mucosa. Results: A total of 124 patients participated in the study. There was a positive correlation between villous blood flow change and exocrine pancreas function (R = 0.4337, P < 0.0001). Changes of gastric inhibitory polypeptide and glucagon-like peptide messenger RNAs in biopsy samples were positively correlated with endocrine pancreas function in 88 patients without treatment for diabetes (R = 0.4314, P = 0.0012; R = 0.4112, P = 0.0081). In patients with lower villous blood flow change and decreased pancreatic exocrine function, the prognostic nutritional index were significantly lower (P = 0.0098), compared with other patients. Conclusions: This study provides the first evidence of a close functional correlation between the pancreas and the small intestine.

DOI： 10.1097/MPA.0000000000001039

Development and validation of a new scoring system to determine the necessity of small-bowel endoscopy in obscure gastrointestinal bleeding 査読有り

Endoscopic ultrasound in diagnosis of solid pancreatic lesions: Elastography or contrast-enhanced harmonic alone versus the combination.

Chantarojanasiri T, Hirooka Y, Kawashima H, Ohno E, Kuwahara T, Yamamura T, Funasaka K, Nakamura M, Miyahara R, Ishigami M, Watanabe O, Hashimoto S, Hirakawa A, Ratanachu-Ek T, Goto H

Endoscopy international open 5 巻 ( 11 ) 頁： E1136 - E1143 2017年11月

Uchida Genta, Nakamura Masanao, Watanabe Osamu, Yamamura Takeshi, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Goto Hidemi, Hirooka Yoshiki

DIGESTIVE AND LIVER DISEASE 49 巻 ( 11 ) 頁： 1218 - 1224 2017年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Digestive and Liver Disease

Background Small bowel capsule endoscopy (SBCE) is the recommended first-line procedure for obscure gastrointestinal bleeding (OGIB). However, a method for predicting the necessity of subsequent double-balloon endoscopy (DBE) has not been established. Aims We aimed to develop a new scoring system that predicts the necessity of DBE in OGIB. Methods A retrospective study was performed in 330 patients who underwent SBCE for OGIB at Nagoya University Hospital. The enrolled patients were randomly assigned to either a development or a validation dataset. The former was used to construct a prediction scoring system to assess the necessity of DBE using independent predictors selected by logistic regression. The diagnostic yield of the prediction model was assessed using the validation dataset. Results Multivariate logistic regression analysis of the development dataset identified OGIB type, blood transfusion, and SBCE findings as independent predictors of the necessity of DBE. A prediction score gave an area under the receiver operating characteristics curve of 0.77. The sensitivity, specificity, positive predictive value, and negative predictive value at a cutoff ≥2.5 points were 72.5%, 74.6%, 72.6%, and 74.5%, respectively. Conclusion Our scoring system may aid clinicians in deciding when to recommend DBE for patients with OGIB.

DOI： 10.1016/j.dld.2017.08.036

【臓器間ネットワークからみた肝胆膵の恒常性とその破綻】正常状態での肝胆膵領域の臓器間ネットワーク小腸内視鏡拡大観察を用いた機能的膵小腸相関の解明

酒井大輔, 廣岡芳樹, 川嶋啓揮, 大野栄三郎, 石川卓哉, 須原寛樹, 竹山友章, 橋詰清孝, 小屋敏也, 田中浩敬, 飯田忠, 西尾亮, 鈴木博貴, 松下正伸, 山村健史, 古川和宏, 舩坂好平, 中村正直, 宮原良二, 渡辺修, 後藤秀実

肝胆膵 75 巻 ( 5 ) 頁： 929 - 936 2017年11月

<i>In vivo</i> histological diagnosis for gastric cancer using endocytoscopy 査読有り

Tsurudome Issei, Miyahara Ryoji, Funasaka Kohei, Furukawa Kazuhiro, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Nakaguro Masato, Satou Akira, Hirooka Yoshiki, Goto Hidemi

WORLD JOURNAL OF GASTROENTEROLOGY 23 巻 ( 37 ) 頁： 6894 - 6901 2017年10月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：World Journal of Gastroenterology

Aim To examine usefulness of virtual biopsy using endocytoscopy by comparing the in vivo endocytoscopic and histopathological images of gastric cancers. METHODS Endocytoscopy was performed in 30 patients with early gastric cancer. Of these, 26 patients showed well differentiated adenocarcinomas, while 4 patients showed poorly differentiated adenocarcinomas (including one signet ring cell carcinoma). Cancerous and non-cancerous areas were observed after double staining with 0.05% crystal violet and 0.1% methylene blue. The endocytoscopic images obtained were evaluated by an expert endoscopist and an expert pathologist without knowledge of patient clinical data, and endocytoscopic and histopathological diagnoses were compared. RESULTS The endocytoscopic images of the cancerous area were assessed as evaluable in 25 (83.3%) and 27 (90%) patients by endoscopist A and pathologist B, respectively, and those of the non-cancerous area as evaluable in 28 (93.3%) and 23 (76.7%) patients by the endoscopist and pathologist, respectively. The sensitivity, specifcity, and diagnostic accuracy of gastric cancer diagnosis using evaluable endocytoscopic images were 88.0% and 92.9%, and 90.6% by endoscopist A, and 88.9% and 91.3%, and 90.0% by pathologist B, respectively. Evaluation of the diagnostic concordance rate between the endoscopist and the pathologist by inter-observer agreement calculation revealed no significant difference between the two observers. The inter-observer agreement (-value) for endocytoscopic diagnosis was 0.745. CONCLUSION Endocytoscopy is useful for the differentiation of cancerous from non-cancerous gastric mucosa, making it a promising tool for virtual biopsy.

DOI： 10.3748/wjg.v23.i37.6894

Proton pump inhibitor therapy did not increase the prevalence of small-bowel injury: A propensity-matched analysis 国際誌

ETV1 expression would be a predictive marker of malignancy in GIST

Funasaka Kohei, Miyahara Ryoji, Furukawa Kazuhiro, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Hirooka Yoshiki, Goto Hidemi

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 32 巻頁： 79-80 2017年9月

Making decision to treat with infliximab by the result of periodic surveillance with double-balloon endoscopy after ilectomy can obtain mucosal healing and avoid re-operation on patients with Crohn's disease for a long-term follow-up study

Watanabe Osamu, Nakamura Masanao, Yamamura Takeshi, Matsushita Masanobu, Saito Masashi, Matsuura Rinzaburou, Sawada Tsunaki, Mizutani Yasuyuki, Niwa Yoshiki, Ishikawa Eri, Uchida Genta, Otsuka Hiroyuki, Suzuki Hiroto, Nishikawa Takahiro, Ishida Tetsuya, Yamada Keishi, Kuno Takeshi, Hattori Shun, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hirooka Yoshiki, Goto Hidemi

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 32 巻頁： 287 - 287 2017年9月

ETV1 expression would be a predictive marker of malignancy in GIST

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 32 巻頁： 79-80 2017年9月

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 32 巻頁： 287-287 2017年9月

Yamada Atsuo, Niikura Ryota, Maki Koutarou, Nakamura Masanao, Watabe Hirotsugu, Fujishiro Mitsuhiro, Oka Shiro, Fujimori Shunji, Nakajima Atsushi, Ohmiya Naoki, Matsumoto Takayuki, Tanaka Shinji, Koike Kazuhiko, Sakamoto Choitsu

PLOS ONE 12 巻 ( 8 ) 頁： e0182586 2017年8月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：PLoS ONE

Background: Previous studies have reported that the suppression of acid secretion by using proton pump inhibitors (PPIs) results in dysbiosis of the small-bowel microbiota, leading to exacerbated small-bowel injuries, including erosions and ulcers. This study was designed to assess the association between PPI therapy and small-bowel lesions after adjustment for the differences in baseline characteristics between users and non-users of PPIs. Methods: We retrospectively studied patients suspected to be suffering from small-bowel diseases, who underwent capsule endoscopy between 2010 and 2013. We used propensity matching to adjust for the differences in baseline characteristics between users and non-users of PPIs. The outcomes included the prevalence of small-bowel lesions: erosion, ulcer, angioectasia, varices, and tumor. Results: We selected 327 patient pairs for analysis after propensity matching, and found no significant differences in the prevalence of small-bowel injuries, including erosions and ulcers, between users and non-users of PPIs. Two subgroup analyses of the effect of the type of PPI and the effect of PPI therapy in users and non-users of nonsteroidal anti-inflammatory drugs indicated no significant differences in the prevalence of small-bowel injuries in these two groups. Conclusion: PPI therapy did not increase the prevalence of small-bowel injury, regardless of the type of PPI used and the use of nonsteroidal anti-inflammatory drugs.

DOI： 10.1371/journal.pone.0182586

Clinical factors related to false-positive rates of patency capsule examination 査読有り

Sawada Tsunaki, Nakamura Masanao, Watanabe Osamu, Yamamura Takeshi, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Elzaburo, Kawashima Hiroki, Miyahara Ryoji, Goto Hidemi, Hirooka Yoshiki

THERAPEUTIC ADVANCES IN GASTROENTEROLOGY 10 巻 ( 8 ) 頁： 589 - 598 2017年8月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Therapeutic Advances in Gastroenterology

Background Retention is the most common complication of capsule endoscopy (CE), and is reported to occur in 0-13% of cases. To avoid retention, a PillCam patency capsule (PC) is used in patients with suspected intestinal stenosis. However, a relatively low positive predictive value of the PC examination has been reported previously. The aims of this study were to clarify the accuracy of PC examination and to evaluate clinical factors related to cases of false-positive detection. Methods We performed a retrospective single-center study of 282 consecutive patients referred for PC examination. Patients in which the PC could not pass through the small bowel within 33 h were classified into the 'no patency' group. The 'no patency' group was investigated for evidence of significant stenosis upon further examinations, including CE, double-balloon endoscopy, and small bowel follow-through after PC examination. Clinical factors related to small bowel patency and false-positive cases were evaluated. Results We included 161 male (57.1%) and 121 female (42.9%) patients with a mean age of 47.5 ± 17.7 years. Of the 282 patients enrolled, 27 patients exhibited 'no patency' upon PC examination. Multivariate analysis showed that clinical factors related to 'no patency' included Crohn's disease, abdominal symptoms, stenosis upon imaging, and previous abdominal surgery. Upon further examination, nine cases in the 'no patency' group had significant stenosis. Sensitivity, specificity, and negative and positive predictive values of PC examination for detecting small bowel stenosis were 93.8%, 96.6%, 99.6%, and 62.5%, respectively, and the only clinical factor related to false-positive cases was constipation (p < 0.05). Conclusion We found a relatively low positive predictive value of PC examination and that constipation was related to false-positive results. To extend the implications of CE indications, clinical study focusing on these results is expected.

DOI： 10.1177/1756283X17722744

Quantitative diagnosis of chronic pancreatitis using EUS elastography

Kuwahara Takamichi, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Kawai Manabu, Suhara Hiroki, Takeyama Tomoaki, Hashizume Kiyotaka, Koya Toshinari, Tanaka Hiroyuki, Sakai Daisuke, Yamamura Takeshi, Furukawa Kazuhiro, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Ishigami Masatoshi, Hashimoto Senju, Goto Hidemi

JOURNAL OF GASTROENTEROLOGY 52 巻 ( 7 ) 頁： 868 - 874 2017年7月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Gastroenterology

Background: It is difficult to diagnose chronic pancreatitis (CP) objectively because of a lack of standard diagnostic criteria. Endoscopic ultrasonography (EUS) has been used to assess the severity of CP, but the diagnosis of CP using EUS depends on an endosnonographer. The aim of this study was to establish an objective diagnostic method for CP using EUS elastography (EUS-EG). Methods: A retrospective study was designed and 96 patients underwent EUS-EG for follow-up of known CP, or who were clinically suspected as having CP. CP patients were categorized CP patients as 4 stages using the Rosemont classification (RC). EUS-EG was performed and the “Mean value”, which was negatively correlated with pancreatic fibrosis, was calculated using histogram analysis. Results: The “Mean value” of each RC stage (normal, indeterminate for CP, suggestive of CP, and consistent with CP) was 90.1 ± 19.3, 73.2 ± 10.6, 63.7 ± 14.2, and 56.1 ± 13.6, respectively, and showed significant differences for each stage (p < 0.001). There was a significant negative correlation between the “Mean value” and the number of EUS features (rs = −0.59, p < 0.001). Multiple linear regression analysis was used to assess the diagnostic finding of the “Mean value” and showed that hyperechoic foci with shadowing and lobularity with honeycombing maintained their independent diagnostic findings. Conclusions: EUS-EG was an objective diagnostic apparatus for CP and provided objective information to support EUS features.

DOI： 10.1007/s00535-016-1296-8

Inhibition of KDM4A activity as a strategy to suppress interleukin-6 production and attenuate colitis induction 査読有り

Ishiguro Kazuhiro, Watanabe Osamu, Nakamura Masanao, Yamamura Takeshi, Matsushita Masanobu, Goto Hidemi, Hirooka Yoshiki

CLINICAL IMMUNOLOGY 180 巻頁： 120 - 127 2017年7月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Clinical Immunology

4-Chloro-7-nitro-2,1,3-benzoxadiazole (NBD-Cl) functions as a hapten and fluoresces upon binding to proteins. Therefore, fluorescence visualization of hapten-proteins is a feature of the colitis induced by NBD-Cl. Using this colitis model, we located activated fibroblasts in the vicinity of hapten-proteins upon colitis induction and observed interleukin (IL)-6 production in the activated fibroblasts. We screened herbal ingredients using primary fibroblasts stimulated with tumor necrosis factor α (TNF-α) and found the suppressive action of Atractylodin on IL-6 production. Under TNF-α stimulation, Atractylodin induced the tri-methylation of histone H3 at lysine residue 9, which impaired the binding between NF-κB and the IL-6 promoter on the genomic DNA. Atractylodin inhibited KDM4A but not KDM6A activity. Atractylodin administration attenuated colitis induction. The KDM4A inhibitor ML324 showed similar actions on IL-6 production and colitis induction. We propose the inhibition of KDM4A activity as a strategy to suppress IL-6 production and attenuate colitis induction.

DOI： 10.1016/j.clim.2017.05.014