Third-Generation High-Vision Ultrathin Endoscopy Using Texture and Color Enhancement Imaging and Narrow-Band Imaging to Evaluate Barrett's Esophagus.

It remains unclear whether texture- and color-enhancement imaging (TXI) and narrow-band imaging (NBI) provide an advantage over white-light imaging (WLI) in Barrett's esophagus. We compared endoscopic findings and color differences between WLI and image-enhanced endoscopy (IEE) using a third-generation ultrathin endoscope. We retrospectively enrolled 40 patients who evaluated Barrett's esophagus using WLI, TXI, and NBI. Color differences determined using the International Commission on Illumination 1976 (L∗, a∗, b∗) color space among Barrett's epithelium, esophageal, and gastric mucosa were compared among the endoscopic findings. As the secondary outcome, we assessed the subjective visibility score among three kinds of endoscopic findings. The prevalence of Barrett's esophagus and gastroesophageal reflux disease (GERD) in WLI was 82.5% and 47.5%, respectively, and similar among WLI, TXI, and NBI. Color differences between Barrett's epithelium and esophageal or gastric mucosa on NBI were significantly greater than on WLI (all p < 0.05). However, the color difference between Barrett's epithelium and esophageal mucosa was significantly greater on NBI than TXI (p < 0.001), and the visibility score of Barrett's epithelium detection was significantly greater on TXI than NBI (p = 0.022), and WLI (p = 0.016). High-vision, third-generation ultrathin endoscopy using NBI and TXI is useful for evaluating Barrett's epithelium and GERD compared with WLI alone.

Endoscopic Reflux Esophagitis and Reflux-Related Symptoms after Helicobacter pylori Eradication Therapy: Meta-Analysis.

Backgrounds: The etiology of gastroesophageal reflux disease (GERD) including reflux esophagitis and non-erosive reflux disease is multifactorial and a recent meta-analysis showed no association between the development of GERD and Helicobacter pylori eradication in both Western and East-Asian populations. However, the problem remains that various inclusion criteria are used in these studies, which hinders meta-analysis. With a focus on reflux esophagitis with endoscopic mucosal injury, we meta-analysed to evaluate the association between eradication and reflux esophagitis and symptoms using a clearly defined set of inclusion criteria. Methods: We conducted a meta-analysis of studies published up until March 2020, which compared the incidence of reflux esophagitis and symptoms between patients undergoing H. pylori eradication therapy in a randomized placebo-controlled trial (Category A); between patients with successful and failed eradication (Category B); and between patients with successful vs. failed eradication, receipt of placebo, or no-treatment H. pylori-positives (Category C). Results: A total of 27 studies were included. Significant statistical effects were found for development of endoscopic reflux esophagitis [relative risk (RR): 1.46, 95% confidence interval (CI): 1.16-1.84, p = 0.01] or de novo reflux esophagitis (RR: 1.42, 95% CI: 1.01-2.00, p = 0.03) in the case group that received eradication in all studies, especially in Western populations. There was no significant difference in the incidence of symptoms after eradication between patient and control groups, regardless of category, location of population, or baseline disease. Conclusions: Eradication therapy for H pylori increases the risk of reflux esophagitis, irrespective of past history of esophagitis. In contrast, no effect was seen on reflux-related symptoms.

Differences in efficacy and safety of lubiprostone used for idiopathic vs opioid-induced constipation: meta-analysis of East Asian and Western populations.

Several secretagogues, such as lubiprostone, have been developed for the treatment of constipation in the last 10 years. It is unclear whether the efficacy of lubiprostone for spontaneous bowel movement (SBM) and the adverse events are similar between idiopathic and opioid-induced constipation and between East-Asian and Western populations. We conducted a meta-analysis to compare efficacy and safety of lubiprostone in two populations with idiopathic vs opioid-induced constipation. The PubMed and Cochrane databases were searched for relevant randomized control trials (RCTs) investigating the efficacy and safety that were published in English up to March 2019. Compared with the placebo groups in idiopathic and opioid-induced constipation, the lubiprostone groups significantly improved in 24-h SBM frequency [relative risk: 1.28, 95% confidence interval, 1.11-1.49, and 1.23, 1.14-1.32] and weekly frequency >3 SBM/week (1.68, 1.41-2.01, and 1.43, 1.01-2.04), respectively. Although the incidence of adverse events was similar between idiopathic and opioid-induced constipation, the incidence of nausea in Western populations with idiopathic constipation was significantly higher (29.2%) than that in East-Asian populations (10.0%, p<0.001). In conclusion, lubiprostone effectively improved SBM frequency, irrespective of the etiology of constipation and population. The incidence of nausea was significantly higher in Western populations.

Clarithromycin Versus Metronidazole in First-Line Helicobacter Pylori Triple Eradication Therapy Based on Resistance to Antimicrobial Agents: Meta-Analysis.

BACKGROUND: International treatment guidelines for Helicobacter pylori infection recommend a proton pump inhibitor (PPI)/amoxicillin/clarithromycin (CAM) regimen (PAC) or PPI/amoxicillin/metronidazole (MNZ) regimen (PAM) as first-line therapy based on culture and sensitivity testing. As incidence rates of antimicrobial agent-resistant strains are changing year by year, it is important to reevaluate the efficacy of eradication regimens. We performed a meta-analysis to evaluate the efficacy and safety of PAC and PAM based on different locations categorized by the reported incidence of CAM- and MNZ-resistant strains. METHODS: Randomized control trials (RCTs) comparing eradication rates between PAC and PAM first-line treatment up to December 2018 were included. We divided RCTs into four groups based on resistance to CAM (< 15% or ≥ 15%) and MNZ (< 15% or ≥ 15%). RESULTS: A total of 27 studies (4825 patients) were included. Overall eradication rates between PAC and PAM were similar (74.8% and 72.5%, relative risk (RR): 1.13, 95% confidence interval (CI): 0.91-1.39, P = 0.27) in the intention-to-treat analysis. In areas with low MNZ- and high CAM-resistance rates, PAM had a significantly higher eradication rate than PAC (92.5% vs. 70.8%, RR: 0.29, 95% CI: 0.13-0.68). In areas with high MNZ- and low CAM-resistance rates, the eradication rate with PAC was only 72.9%. CONCLUSIONS: Overall eradication rates with PAC and PAM were equivalent worldwide. In low MNZ-resistance areas, PAM may be recommended as first-line therapy. However, the efficacy of PAC may be insufficient, irrespective of susceptibility to CAM.

A retrospective study on analgesic requirements for thoracoscopic surgery postoperative pain.

BACKGROUND: Thoracoscopic surgery (TS) has been performed as a minimally invasive procedure since the beginning of the 1990s. This has led to a dramatic change in the postoperative condition of these patients, facilitating early ambulation and easier management of postoperative pain. However, empirical evidence on postoperative pain management after TS is limited. The aims of this study were to determine the efficacy and adequacy of postoperative analgesic medications and to simplify the choice of additional drugs based on a numerical rating scale (NRS). MATERIALS AND METHODS: A retrospective study of patients who underwent TS was performed to evaluate postoperative pain, analgesia requirements, and the number of drugs needed during the perioperative period based on the NRS score. RESULTS: Of the 524 patients, mild pain was noted in 87% patients on the day of the operation and in 75.6% patients on ambulation. The mean NRS score was 1.83±1.49 on the day of the operation and 2.73±1.75 on ambulation. An NRS score of 3 on both the day of operation and on ambulation was defined as the necessary condition for improved pain management. Multivariate analysis showed that high surgical stress significantly influenced pain scores. Reduction in pain with an NRS score of ≥1 was significant with the addition of pentazocine hydrochloride (p<0.01) and flurbiprofen (p<0.01). Interestingly, the addition of tramadol was borderline efficacious (p=0.05) in patients with an NRS score of >3 on ambulation. CONCLUSION: A small number of patients have moderate-to-severe pain after TS. Tramadol demonstrated borderline efficacy in controlling postoperative intense pain with an NRS score of ≥3.

[Survey of levels of asthma control among Japanese patients in general practice].

BACKGROUND: The purpose of this study was to investigate the levels of asthma control in Japanese adult patients in general practice. METHODS: 11490 Japanese patients with adult asthma who were treated by primary care physicians were enrolled. The treatment steps and levels of asthma control were determined according to the Japanese Asthma Prevention and Management Guideline 2009. In addition, patient satisfaction with asthma management was scored from 0 (dissatisfied) to 10 (fully satisfied). RESULTS: Inhaled corticosteroids were administered to 90.9% of patients. Of 11490 patients, the percentage of patients undergoing treatment steps 1, 2, 3, and 4 were 41.8%, 31.7%, 28.4%, and 22.1%, respectively. The average scores of satisfaction with asthma treatment in treatment steps 1, 2, 3, and 4 were 7.83, 7.68, 7.62 and 7.46, respectively. CONCLUSIONS: Although a large number of patients were treated with inhaled corticosteroids and the rate of satisfaction with asthma management was high in all treatment steps, asthma was poorly controlled in this study. This dissociation was considered to be due to low patient's own goals of asthma treatment.