A case of diverticular colitis with lesions resembling ulcerative colitis and correlation of tumor necrosis factor-alpha staining with clinical manifestations.

A 45-year-old male with a 3-month history of abdominal pain and melena underwent colonoscopy (CS) at our hospital in May 2009. He was diagnosed with diverticular colitis based on findings of redness around diverticula in the sigmoid colon and biopsy findings of non-specific inflammation. The second CS, which was performed in July 2009 to investigate relapse, showed diffuse redness around diverticula in the sigmoid colon. As seen in active ulcerative colitis (UC), the formation of crypt abscesses was observed in the biopsy. Although the patient was making satisfactory progress after administration of oral mesalazine, CS was performed again in September 2011 because of recurrence of melena, which revealed redness and erosion around diverticula in the ascending and sigmoid colon. Biopsy findings were similar to those of active UC. Immunohistochemical staining of the biopsy specimen with anti-tumor necrosis factor (TNF)-a antibody showed 80 % of lymphocytes were positive for TNF-a compared with 20 % at the first biopsy. The patient's symptoms subsided with an increase in the dose of mesalazine and concurrent administration of prednisolone at 10 mg. He has remained on oral mesalazine and is currently asymptomatic. The findings of this study suggested a correlation between clinical manifestations and the proportion of TNF-a-positive lymphocytes.

Clinical features of eosinophilic esophagitis: ten Japanese cases.

AIM: We studied eosinophilic esophagitis (EE) to clarify the clinical and endoscopic features of a Japanese case series. METHODS: Records of 10 patients diagnosed with EE at our hospital between May 2010 and December 2011 were examined for age, sex, symptoms, allergic disorder, endoscopic findings, and treatment received. Esophageal wall thickness was measured by endoscopic ultrasonography (EUS). RESULTS: Patients were seven males and three females with a mean age of 48 years. Symptoms included dysphagia, heartburn, food impaction, and chest pain. Nine patients had a history of allergic diseases. Increased peripheral eosinophil count was observed in one patient whereas increased immunoglobulin E level was observed in eight patients. Endoscopic findings included longitudinal furrows in all patients, mucosal edema in nine patients, loss of vascular pattern in nine patients, white exudates in six patients, cobblestone-like appearance in five patients, and concentric rings in three patients. EUS revealed thickening of the esophageal wall in one patient. Histopathological examination revealed eosinophilic infiltration (≥15 eosinophils/high-powered field) in the esophageal epithelium of all patients. Treatment was required in six patients. Proton pump inhibitor (PPI) therapy was given as the first-line treatment but was ineffective in four patients and effective in two patients. Steroid therapy was given to three patients unresponsive to PPI therapy and was effective. CONCLUSIONS: EE was common among relatively young men and was associated with allergic diseases. Longitudinal furrows were observed as the most characteristic endoscopic finding. Esophageal wall thickening was not commonly observed by EUS.

[Diagnosis of the depth of gastric cancer invasion by endoscopic ultrasonography].

Endoscopic ultrasonography (EUS) is useful to diagnose the depth of invasion because of obtaining tomographic image of gastric cancer. Stomach layer has a 5-layer structure. Gastric cancer is visualized as low echoic tumor image by EUS. Massive invasion of gastric cancer is viewed as low echoic and clear boundary image. Diffuse invasion is imaged unclear boundary echo and visualized thick layer with remaining layer structure. Invasion depth of gastric cancer by EUS is diagnosed according to level of wall destruction. When depressed type cancer has ulceration in cancer nest, echoic image is modified with fibrous tissue. The diagnostic criteria of depressed type cancer classified into EUS imaging of cancer in consideration for image modified by fibrous tissue accompanied ulceration.

[New guideline for peptic ulcer treatment, attention to low-dose aspirin].

The guideline for peptic ulcer treatment was reported in 2009. In the guideline, eight clinical questions were chosen for peptic ulcers associated with use of low-dose aspirin. Five questions out of them were related to the clinical behavior, and three were the treatment of peptic ulcers in patients taking low-dose aspirin. The statements were made for these questions according to EBM respectively. In the statements, the grade of recommendation, the evidence level of literatures and the application to Japanese medical insurance were mentioned.

Involvement of NAD(P)H:quinone oxidoreductase 1 and superoxide dismutase polymorphisms in ulcerative colitis.

Inflammatory bowel disease is a multifactorial disease. Oxidative stress has been thought to be one of etiologic factor for inflammatory bowel disease. The genes superoxide dismutase (SOD2) and NAD(P)H:quinone oxidoreductase 1 (NQO1) are involved in inflammation and oxidative stress. The purpose of the present case-control study with 134 patients with ulcerative colitis (UC) and 125 healthy controls was to determine whether polymorphisms of these genes, the NQO1 C609T and the SOD2 Ala-9Val, are associated with the risk of UC and influence the clinical characteristics. These polymorphisms were examined by polymerase chain reaction-restriction fragment length polymorphisms and direct sequencing. In patients showing steroid resistance, the number with the NQO1 T/T genotype was significantly higher than other genotypes (odds ratio 9.45, 95% confidence interval 2.46-41.6, p = 0.002). In the patients whose onset of UC was age 20 years or younger, more patients had SOD2 T/T genotype than the other genotypes (odds ratio 6.46, 95% confidence interval 0.82-51.0). No association between these polymorphisms and UC risk was apparent. The NQO1 C609T polymorphism may influence steroid resistance of UC patients, while the SOD2 Ala-9Val polymorphism may influence age of onset of UC. Oxidative stress may influence the clinical features of UC.

Impact of lipoprotein lipase gene polymorphisms on ulcerative colitis.

AIM: To examine the influence of lipoprotein lipase (LPL) gene polymorphism in ulcerative colitis (UC) patients. METHODS: Peripheral blood was obtained from 131 patients with UC and 106 healthy controls for DNA extraction. We determined LPL gene polymorphisms affecting the enzyme at Ser447stop, as well as Hind III and Pvu II polymorphisms using PCR techniques. PCR products were characterized by PCR-RFLP and direct sequencing. Polymorphisms were examined for association with clinical features in UC patients. Genotype frequencies for LPL polymorphisms were also compared between UC patients and controls. RESULTS: In patients with onset at age 20 years or younger, C/G and G/G genotypes for Ser447stop polymorphism were more prevalent than C/C genotype (OR = 3.13, 95% CI = 0.95-10.33). Patients with H(+/-) or H(-/-) genotype for Hind III polymorphism also were more numerous than those with H(+/+) genotype (OR = 2.51, 95% CI = 0.85-7.45). In the group with H(+/+) genotype for Hind III polymorphism, more patients had serum triglyceride concentrations over 150 mg/dL than patients with H(+/-) or H(-/-) genotype (P < 0.01, OR = 6.46, 95% CI = 1.39-30.12). Hypertriglycemia was also more prevalent in patients with P(+/+) genotypes for Pvu II polymorphism (P < 0.05, OR = 3.0, 95% CI = 1.06-8.50). Genotype frequency for LPL polymorphism did not differ significantly between UC patients and controls. CONCLUSION: Ser447stop and Hind III LPL polymorphisms may influence age of onset of UC, while Hind III and Pvu II polymorphisms influence serum triglyceride in UC patients.