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Ueda T, Koyama F, Sugita A, Ikeuchi H, Futami K, Fukushima K, Nezu R, Iijima H, Mizushima T, Itabashi M, Watanabe K, Hata K, Shinagawa T, Matsuoka K, Takenaka K, Sasaki M, Nagayama M, Yamamoto H, Shinozaki M, Fujiya M, Kato J, Ueno Y, Tanaka S, Okita Y, Hashimoto Y, Kobayashi T, Koganei K, Uchino M, Fujii H, Suzuki Y, Hisamatsu T. Endoscopic Lesions of Postoperative Anastomotic Area in Patients With Crohn's Disease in the Biologic Era: A Japanese Multi-Centre Nationwide Cohort Study. J Crohns Colitis 2023; 17:1968-1979. [PMID: 37450892 DOI: 10.1093/ecco-jcc/jjad116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND AIMS Many patients have endoscopic evidence of recurrent Crohn's disease [CD] at 1 year after intestinal resection. These lesions predict future clinical recurrence. We endoscopically evaluated postoperative anastomotic lesions in CD patients from a large cohort of postoperative CD patients. METHODS We retrospectively enrolled CD patients who underwent surgical resection between 2008 and 2013 at 19 inflammatory bowel disease [IBD]-specialist institutions. The initial analyses included patients who underwent ileocolonoscopy ~1 year after intestinal resection. Follow-up analyses assessed any changes in the endoscopic findings over time. We evaluated the postoperative endoscopic findings, which were classified into four categories [no lesion, mild, intermediate, severe] at the sites of the anastomotic line and peri-anastomosis. RESULTS In total, 267 CD patients underwent postoperative ileocolonoscopy. Postoperative anastomotic lesions were widely detected in index ileocolonoscopy [61.0%] and were more frequently detected in follow-up ileocolonoscopy [74.9%]. Endoscopic severity also increased. Patients with intermediate or severe peri-anastomotic or anastomotic line lesions at the index ileocolonoscopy required significantly more interventions, including endoscopic dilatation or surgery, than patients with mild lesions or no lesions. CONCLUSIONS Frequent anastomotic lesions were observed at the postoperative index ileocolonoscopy. These gradually increased for subsequent ileocolonoscopy, even in the biologic era. Regarding lesions on the anastomotic line, intermediate lesions on the anastomotic line [e.g. irregular or deep ulcers] might be considered recurrent disease, and mild lesions [e.g. linear superficial ulcers] might be considered non-recurrent disease. Prospective studies are needed to resolve this issue, including treatment enhancement.
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Affiliation(s)
- Takeshi Ueda
- Department of Surgery, Nara Medical University, Kashihara, Japan
- Sai Gastroenterology and Proctology Clinic, Fujiidera, Japan
| | - Fumikazu Koyama
- Department of Surgery, Nara Medical University, Kashihara, Japan
- Division of Endoscopy, Nara Medical University Hospital, Kashihara, Japan
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Hiroki Ikeuchi
- Department of Gastroenterological Surgery, Division of Inflammatory Bowel Disease Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Kitaro Futami
- Department of Surgery, Fukuoka University Chikushi Hospital, Chikusino, Japan
| | | | - Riichiro Nezu
- Department of Surgery, Osaka Central Hospital, Osaka, Japan
| | - Hideki Iijima
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, and Department of Gastroenterology, Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan
| | - Tsunekazu Mizushima
- Department of Therapeutics for Inflammatory Bowel Diseases, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Michio Itabashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhiro Watanabe
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
- Nihonbashi Muromachi Mitsui Tower Midtown Clinic, Tokyo, Japan
| | | | - Katsuyoshi Matsuoka
- Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kento Takenaka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Sasaki
- Division of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Manabu Nagayama
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Masaru Shinozaki
- Department of Surgery, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan, and Saitama Gastroenterological Clinic, Saitama, Japan
| | - Mikihiro Fujiya
- Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Jun Kato
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshitaka Ueno
- Department of Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshiki Okita
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | | | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Motoi Uchino
- Department of Gastroenterological Surgery, Division of Inflammatory Bowel Disease Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Hisao Fujii
- Gastrointestinal Endoscopy and IBD Center, Yoshida Hospital, Nara, Japan
| | - Yasuo Suzuki
- Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
- Ginza Central Clinic, Tokyo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
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Tatsuno M, Koganei K, Tatsumi K, Kuroki H, Obara N, Saitoh S, Sugita A. [A case of ulcerative colitis complicated by disseminated intravascular coagulation that improved markedly after surgery]. Nihon Shokakibyo Gakkai Zasshi 2023; 120:680-688. [PMID: 37558415 DOI: 10.11405/nisshoshi.120.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
A 57-year-old man presenting with severe ulcerative colitis (UC) complicated by disseminated intravascular coagulation (DIC) was referred to our hospital. Since it was difficult to improve DIC immediately with any medical treatment, total proctocolectomy, ileoanal canal anastomosis, and ileostomy were performed on the patient. Soon after the surgery, his platelet count and coagulability improved, and he recovered from DIC. Thus, when the cause of DIC is probably UC itself, and medical treatment has limited efficacy in improving the DIC, surgery should be performed as soon as possible to eliminate the cause of DIC, considering the general condition of the patient.
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Affiliation(s)
- Mizuki Tatsuno
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Nao Obara
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Sayumi Saitoh
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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Kuroki H, Sugita A, Koganei K, Tatsumi K, Nakao E, Obara N. Postoperative results and complications of fecal diversion for anorectal Crohn's disease. Surg Today 2023; 53:386-392. [PMID: 35867163 PMCID: PMC9950159 DOI: 10.1007/s00595-022-02556-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Fecal diversion is a less-invasive technique that can alleviate symptoms in patients with refractory anorectal Crohn's disease. However, complications, including recurrence of residual anorectal Crohn's disease, may develop. We aimed to evaluate the postoperative results and complications associated with fecal diversion in patients with refractory anorectal Crohn's disease. METHODS We enrolled 1218 Crohn's disease patients who underwent laparotomy at our institute. We retrospectively analyzed the clinical features of 174 patients who underwent fecal diversion for refractory anorectal Crohn's disease, complications of the diverted colorectum, and the incidence and risk factors for proctectomy after fecal diversion. RESULTS After fecal diversion, 74% of patients showed improved symptoms. However, bowel continuity restoration was successful in four patients (2.2%), and anorectal Crohn's disease recurred in all patients. Seventeen patients developed cancer with a poor prognosis. The rate of conversion to proctectomy after fecal diversion was 41.3%, and the risk factors included rectal involvement (p = 0.02), loop-type stoma (p < 0.01), and the absence of treatment with biologics after fecal diversion (p = 0.03). CONCLUSION Fecal diversion for refractory anorectal Crohn's disease can improve clinical symptoms. Patients with rectal involvement or loop-type stoma have a greater risk of requiring proctectomy following fecal diversion. The administration of biologic may decrease the rate of proctectomy.
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Affiliation(s)
- Hirosuke Kuroki
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan.
| | - Akira Sugita
- grid.417366.10000 0004 0377 5418Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855 Japan
| | - Kazutaka Koganei
- grid.417366.10000 0004 0377 5418Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855 Japan
| | - Kenji Tatsumi
- grid.417366.10000 0004 0377 5418Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855 Japan
| | - Eiichi Nakao
- grid.417366.10000 0004 0377 5418Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855 Japan
| | - Nao Obara
- grid.417366.10000 0004 0377 5418Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855 Japan
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Kuwabara H, Kimura H, Kunisaki R, Tatsumi K, Koganei K, Sugita A, Katsumata K, Tsuchida A, Endo I. Postoperative complications, bowel function, and prognosis in restorative proctocolectomy for ulcerative colitis-a single-center observational study of 320 patients. Int J Colorectal Dis 2022; 37:563-572. [PMID: 34751417 DOI: 10.1007/s00384-021-04059-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine the selection criteria, postoperative complications, bowel function, and prognosis of stapled ileal pouch-anal anastomosis (IPAA) and hand-sewn IPAA for ulcerative colitis (UC). METHODS We defined our surgical indications and strategy, and compared the postoperative complications, bowel function, and prognoses between patients who underwent stapled and hand-sewn IPAA for UC at the Yokohama City University Medical Center between 2004 and 2017. RESULTS Among 320 patients enrolled, 298 patients underwent stapled IPAA while 22 underwent hand-sewn IPAA. There was no significant difference in the postoperative complications between the two groups. Regarding postoperative bowel function, stapled IPAA caused significantly less soiling (stapled vs hand-sewn: 9.1% vs 41.0%, odds ratio (OR) = 0.14, p < 0.0002), spotting (stapled vs hand-sewn: 23.2% vs 63.6%, OR = 0.17, p < 0.0001), and difficulty in distinguishing feces from flatus (stapled vs hand-sewn: 39.9% vs 63.6%, OR = 0.36, p < 0.026). No postoperative neoplasia was observed at the final follow-up in all patients. CONCLUSION In this study, there was no clear difference in the postoperative complications between stapled and hand-sewn IPAA, but stapled IPAA resulted in better postoperative bowel function. Postoperative oncogenesis from the residual mucosa is rare. However, future cancer risk remains; thus, careful follow-up is required.
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Affiliation(s)
- Hiroshi Kuwabara
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urahune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku Ward, Tokyo, 160-0012, Japan
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urahune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urahune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Kenji Tatsumi
- Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa Ward, Yokohama, Kanagawa, 221-0855, Japan
| | - Kazutaka Koganei
- Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa Ward, Yokohama, Kanagawa, 221-0855, Japan
| | - Akira Sugita
- Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa Ward, Yokohama, Kanagawa, 221-0855, Japan
| | - Kenji Katsumata
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku Ward, Tokyo, 160-0012, Japan
| | - Akihiko Tsuchida
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku Ward, Tokyo, 160-0012, Japan
| | - Itaru Endo
- Department of Gastrointestinal Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa Ward, Yokohama, 236-0004, Japan
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Kishi M, Hirai F, Takatsu N, Hisabe T, Takada Y, Beppu T, Takeuchi K, Naganuma M, Ohtsuka K, Watanabe K, Matsumoto T, Esaki M, Koganei K, Sugita A, Hata K, Futami K, Ajioka Y, Tanabe H, Iwashita A, Shimizu H, Arai K, Suzuki Y, Hisamatsu T. A review on the current status and definitions of activity indices in inflammatory bowel disease: how to use indices for precise evaluation. J Gastroenterol 2022; 57:246-266. [PMID: 35235037 PMCID: PMC8938394 DOI: 10.1007/s00535-022-01862-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/06/2022] [Indexed: 02/04/2023]
Abstract
Many clinical trials have been conducted for inflammatory bowel disease (IBD), so various clinical indices (CIs) and endoscopic indices (EIs) have also been evaluated. However, recently, with the progress of IBD management, review of established indices from previous studies, and establishment of new indices, the landscape of the use of indices in clinical trials have changed. We investigated the number and frequency of the indices adapted in recent clinical trials for ulcerative colitis (CI and EI) and Crohn's disease (CI, EI, index related to magnetic resonance imaging, index for evaluating patient-reported outcomes, and health-related quality of life). Based on the results, we selected representative indices and further reviewed their content and characteristics. Moreover, various definitions, including clinical and endoscopic response or remission, have been described by means of representative indices in clinical trials.
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Affiliation(s)
- Masahiro Kishi
- Inflammatory Bowel Disease Center, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Fumihito Hirai
- Department of Gastroenterology, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka 814-0180 Japan
| | - Noritaka Takatsu
- Inflammatory Bowel Disease Center, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Takashi Hisabe
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Yasumichi Takada
- Inflammatory Bowel Disease Center, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Tsuyoshi Beppu
- Inflammatory Bowel Disease Center, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | | | - Makoto Naganuma
- The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Kazuo Ohtsuka
- Department of Endoscopy, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenji Watanabe
- Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Medicine, Iwate Medical University, Iwate, Japan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan
| | - Keisuke Hata
- Nihonbashi Muromachi Mitsui Tower Midtown Clinic, Tokyo, Japan
| | - Kitarou Futami
- Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Hiroshi Tanabe
- Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Akinori Iwashita
- AII Research Institute of Pathology and Image Diagnosis, Fukuoka, Japan
| | - Hirotaka Shimizu
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Katsuhiro Arai
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
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Obara N, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Nakao E, Sugita A. [A case of a patient with Crohn's disease who had vaginal delivery after abdominoperineal resection for severe anorectal complications]. Nihon Shokakibyo Gakkai Zasshi 2021; 118:1079-1084. [PMID: 34759105 DOI: 10.11405/nisshoshi.118.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We report the case of a young female patient with Crohn's disease case who had vaginal delivery after abdominoperineal resection for severe perianal disease. The patient had Crohn's disease with anorectal complications for 13 years and underwent abdominoperineal resection for anorectal stenosis, complex anal fistula, and rectovaginal fistula in her early twenties. Seven years later, she got pregnant and gave birth to a healthy boy by vaginal delivery. No recurrence of Crohn's disease was observed during the perinatal period. There is no curative treatment for severe anorectal complications, which may be necessary for young patients to undergo abdominoperineal resection. Further studies are needed to determine the effects of Crohn's disease with anorectal complications on pregnancy and childbirth in affected patients.
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Affiliation(s)
- Nao Obara
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Eiichi Nakao
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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Matsushima S, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Obara N, Nakao E, Sugita A. [Pregnancy and delivery in patients with Crohn's disease who had a history of abdominal surgery]. Nihon Shokakibyo Gakkai Zasshi 2021; 118:742-748. [PMID: 34373393 DOI: 10.11405/nisshoshi.118.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE A few studies have focused on pregnancy and childbirth in patients with Crohn's disease (CD) who had a history of abdominal surgery. The objective of this study is to analyze the problems of pregnant patients with CD with a history of abdominal surgery. METHODS The rates of pregnancy-related complications and adverse birth outcomes were retrospectively analyzed in 29 patients with CD (45 pregnancies) with previous intestinal surgery. RESULTS In this study, the following outcomes were observed:normal births occurred in 55.6% of the pregnancies, preterm births in 13.3%, and spontaneous abortions in 20.0%. The vaginal birth and cesarean section rates were 45.7% and 40.0%, respectively. The rate of low-birth weight infants was 14.3%. CONCLUSION Overall, patients with CD with previous abdominal surgery can conceive and give birth. However, care needs to be taken to avoid preterm birth, spontaneous abortion, low birth weight, and cesarean delivery.
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Affiliation(s)
- Sayuri Matsushima
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Nao Obara
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Eiichi Nakao
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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Kuroki H, Sugita A, Koganei K, Tatsumi K, Futatsuki R, Nakao E, Obara N, Arai K. Clinicopathological and prognostic evaluations of anorectal cancer after fecal diversion for patients with Crohn's disease. BMC Gastroenterol 2021; 21:168. [PMID: 33849449 PMCID: PMC8045380 DOI: 10.1186/s12876-021-01751-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Colorectum diversion with a proximal stoma is often the preferred surgical approach in patients with Crohn's disease-related anorectal lesions or refractory colitis. To date, few studies have assessed the incidence and prognosis of cancer in the diverted anorectal segments. This study aimed to evaluate the clinical characteristics and prognosis of anorectal cancer associated with Crohn's disease following fecal diversion. METHODS This was a retrospective study based on medical records of patients diagnosed with Crohn's disease between 1999 and 2020. It was conducted at Yokohama Municipal Citizen's Hospital. Patients diagnosed with anorectal cancer following fecal diversion were identified, and their prognosis was the primary outcome measure. RESULTS Among 1615 patients, 232 patients (14%) underwent colorectum diversion. Of those 232 patients, 11 were diagnosed with anorectal cancer following fecal diversion, ten were diagnosed with advanced cancer, 10 underwent abdominoperineal resection, and eight died. 1 could not undergo resection due to multiple lung metastasis and died. The overall five-year survival rate in patients diagnosed with anorectal cancer following fecal diversion was 20%. CONCLUSION Crohn's disease-associated anorectal cancer following fecal diversion was challenging to diagnose early, and patients had a poor prognosis even after curative resection. Early abdominoperineal resection may be considered for patients with Crohn's disease who cannot benefit from cancer screening and surveillance due to difficulty accessing the anorectal stricture via endoscopy.
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Affiliation(s)
- Hirosuke Kuroki
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan.
| | - Akira Sugita
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
| | - Kazutaka Koganei
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
| | - Kenji Tatsumi
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
| | - Ryo Futatsuki
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
| | - Eiichi Nakao
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
| | - Nao Obara
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
| | - Katsuhiko Arai
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishicho Kanagawa-ku, Yokohama City, 221-0855, Japan
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Nakao E, Tatsumi K, Kuroki H, Futatsuki R, Koganei K, Sugita A, Hayashi H, Yokoyama K. [Preoperative diagnosis of small intestinal cancer associated with Crohn's disease: a case report]. Nihon Shokakibyo Gakkai Zasshi 2021; 118:645-651. [PMID: 34248077 DOI: 10.11405/nisshoshi.118.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The patient was a 46-year-old woman with a history of Crohn's disease for several years. At 45 years of age, a colonoscopy was performed, and a protruding lesion in the terminal ileum was detected. Pathological analysis of a biopsy specimen noted high suspicion for a well differentiated adenocarcinoma. The patient underwent ileocecal resection, and histological examination of the specimen revealed that infiltration of the well differentiated adenocarcinoma was limited to the mucosa. To the best of our knowledge, this is the first known case of early small intestinal cancer associated with Crohn's disease in Japan. Both endoscopy and a biopsy of any protruding lesions may be useful for making a preoperative diagnosis of small intestinal cancer associated with Crohn's disease.
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Affiliation(s)
- Eiichi Nakao
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | | | - Kaoru Yokoyama
- Department of Gastroenterology, Kitasato University School of Medicine
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10
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Minagawa Y, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Hayashi H, Suga T, Sugita A. [Familial adenomatous polyposis with papillary thyroid cancer:a case report]. Nihon Shokakibyo Gakkai Zasshi 2020; 117:719-725. [PMID: 32779590 DOI: 10.11405/nisshoshi.117.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The patient is 36-year-old woman who complained of proptosis and was diagnosed as thyroid cancer. The pathologic diagnosis of her resected specimen was papillary thyroid cancer, cribriform morular variant (CMV). Subsequently, she was suspected of having familial adenomatous polyposis (FAP), although she had no family history of it. The diagnosis of FAP was confirmed following colonoscopy, which showed multiple polyps, and the biopsies that revealed multiple adenomas and cancers with APC gene mutation. She underwent restorative proctocolectomy, rectal mucosectomy with ileal pouch anal anastomosis, and ileostomy in our department. Cancer in the adenomas was found in four polyps on histopathological examination. CMV is known to be complicated with FAP. However, the number of reported cases remains few. This case was relatively rare, with an initial diagnosis of FAP because of the coexistence of CMV. In patients with papillary thyroid cancer (CMV type), colonoscopy should be considered because of the possibility of FAP.
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Affiliation(s)
- Yume Minagawa
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hiroyuki Hayashi
- Department of Pathological Diagnosis, Yokohama Municipal Citizen's Hospital
| | - Tomoaki Suga
- Department of Gastroenterology, Shinshu University Hospital
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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11
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Nakao E, Tatsumi K, Kuroki H, Futatsuki R, Koganei K, Sugita A. [A case of ulcerative colitis complicated by internal fistula between the transverse colon and stomach]. Nihon Shokakibyo Gakkai Zasshi 2020; 117:619-625. [PMID: 32655121 DOI: 10.11405/nisshoshi.117.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A case of ulcerative colitis (UC) with an internal fistula was reported;the patient, a 42-year-old male, was admitted to the hospital with a diagnosis of refractory UC. The preoperative examination revealed an internal fistula between the transverse colon and the stomach. UC was diagnosed preoperatively with an internal fistula, but the possibility of Crohn's disease could not be ruled out at that time. The patient underwent subtotal colectomy with end ileostomy, sigmoid colon mucous fistula, and partial gastrectomy. UC was diagnosed histopathologically, and an ileal pouch-anal anastomosis was performed. An internal fistula can complicate UC;a split surgery is recommended with the possibility of Crohn's disease in the patient.
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Affiliation(s)
- Eiichi Nakao
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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12
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Matsushima S, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Obara N, Hayashi H, Sugita A. [A case of ulcerative colitis in an 86-year-old woman undergoing restorative proctocolectomy with ileal pouch-anal canal anastomosis]. Nihon Shokakibyo Gakkai Zasshi 2020; 117:321-326. [PMID: 32281573 DOI: 10.11405/nisshoshi.117.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An 86-year-old woman was diagnosed with ulcerative colitis (UC) in the 1970s. A colonoscopy performed 40 years thereafter revealed a 0-Is lesion in the upper rectum, and pathological examination showed well-differentiated adenocarcinoma. The lesion was diagnosed as colitic cancer based on the pathological findings and the 40-year interval since the diagnosis of total colitis type of UC. The patient was in good overall health with good anal function, based on the clinical examination and manometric study;she wished to undergo sphincter-preserving operation. Restorative proctocolectomy with ileal pouch-anal canal anastomosis that preserved the anal canal mucosa was performed. The postoperative course was good, with a defecation frequency of 4-5 times/day without fecal incontinence, and the patient resumed her preoperative lifestyle with very few alterations. Even in elderly patients aged >80 years who have UC, restorative proctocolectomy is feasible for those in good general health and with relatively good anal function, determined based on the daily defecation activity and anal manometry.
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Affiliation(s)
- Sayuri Matsushima
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | - Nao Obara
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
| | | | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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13
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Watanabe K, Tanida S, Inoue N, Kunisaki R, Kobayashi K, Nagahori M, Arai K, Uchino M, Koganei K, Kobayashi T, Takeno M, Ueno F, Matsumoto T, Mizuki N, Suzuki Y, Hisamatsu T. Evidence-based diagnosis and clinical practice guidelines for intestinal Behçet's disease 2020 edited by Intractable Diseases, the Health and Labour Sciences Research Grants. J Gastroenterol 2020; 55:679-700. [PMID: 32377946 PMCID: PMC7297851 DOI: 10.1007/s00535-020-01690-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/08/2020] [Indexed: 02/04/2023]
Abstract
Behçet's disease (BD) is an intractable systemic inflammatory disease characterized by four main symptoms: oral and genital ulcers and ocular and cutaneous involvement. The Japanese diagnostic criteria of BD classify intestinal BD as a specific disease type. Volcano-shaped ulcers in the ileocecum are a typical finding of intestinal BD, and punched-out ulcers can be observed in the intestine or esophagus. Tumor necrosis factor inhibitors were first approved for the treatment of intestinal BD in Japan and have been used as standard therapy. In 2007 and 2014, the Japan consensus statement for the diagnosis and management of intestinal BD was established. Recently, evidence-based JSBD (Japanese Society for BD) Clinical Practice Guidelines for BD (Japanese edition) were published, and the section on intestinal BD was planned to be published in English. Twenty-eight important clinical questions (CQs) for diagnosis (CQs 1-6), prognosis (CQ 7), monitoring and treatment goals (CQs 8-11), medical management and general statement (CQs 12-13), medical treatment (CQs 14-22), and surgical treatment (CQs 23-25) of BD and some specific situations (CQs 26-28) were selected as unified consensus by the members of committee. The statements and comments were made following a search of published scientific evidence. Subsequently, the levels of recommendation were evaluated based on clinical practice guidelines in the Medical Information Network Distribution Service. The degree of agreement was calculated using anonymous voting. We also determined algorithms for diagnostic and therapeutic approaches for intestinal BD. The present guidelines will facilitate decision making in clinical practice.
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Affiliation(s)
- Kenji Watanabe
- Department of Intestinal Inflammation Research, Hyogo College of Medicine, Hyogo, Japan
| | - Satoshi Tanida
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Nagamu Inoue
- Centers for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Kanagawa, Japan
| | - Kiyonori Kobayashi
- Research and Development Center for New Medical Frontiers, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Masakazu Nagahori
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Motoi Uchino
- Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, Kanagawa, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
| | - Fumiaki Ueno
- Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kanazawa, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Medicine, Iwate Medical University, Iwate, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Yasuo Suzuki
- Inflammatory Bowel Disease Center, Toho University Sakura Medical Center, Chiba, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
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14
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Kuroki H, Sugita A, Koganei K, Tatsumi K, Futatsuki R, Arai K. Two cases of esophageal ulcer after surgical treatment for ulcerative colitis. Clin J Gastroenterol 2019; 13:495-500. [PMID: 31863310 DOI: 10.1007/s12328-019-01082-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 12/11/2019] [Indexed: 01/29/2023]
Abstract
The incidence of postoperative esophageal ulcers has been rarely reported associated with severe ulcerative colitis (UC). We report two cases of esophageal ulcers accompanied by acute necrotizing esophagitis after undergoing surgery for severe UC. Both patients, 47- and 53-year-old, were diagnosed with severe UC and underwent subtotal colectomy with sigmoid mucous fistula and ileostomy. In both cases, they had epigastralgia or digestive track bleeding and upper gastrointestinal endoscopy revealed an esophageal ulcer with acute necrotizing esophagitis accompanied by a black degeneration of mucosa after surgery. Conservative treatments improved the lesions. Esophageal stricture requiring endoscopic dilatation occurred in both cases. An acute UC requiring surgery seems to warrant caution in the merger of esophageal ulcer and acute necrotizing esophagitis.
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Affiliation(s)
- Hirosuke Kuroki
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56, Okazawacho Hodogaya-ku, Yokohama City, 240-8555, Japan.
| | - Akira Sugita
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56, Okazawacho Hodogaya-ku, Yokohama City, 240-8555, Japan
| | - Kazutaka Koganei
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56, Okazawacho Hodogaya-ku, Yokohama City, 240-8555, Japan
| | - Kenji Tatsumi
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56, Okazawacho Hodogaya-ku, Yokohama City, 240-8555, Japan
| | - Ryo Futatsuki
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56, Okazawacho Hodogaya-ku, Yokohama City, 240-8555, Japan
| | - Katsuhiko Arai
- Department of Surgery for Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56, Okazawacho Hodogaya-ku, Yokohama City, 240-8555, Japan
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15
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Sugita A, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Yamada K, Kimura H, Fukushima T. Postoperative functional outcomes and complications of partially intraanal canal anastomosis in stapled ileal pouch anal anastomosis for ulcerative colitis. Int J Colorectal Dis 2019; 34:1317-1323. [PMID: 31175423 DOI: 10.1007/s00384-019-03322-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 02/04/2023]
Abstract
AIM For ulcerative colitis (UC), stapled ileal pouch anal anastomosis (IPAA) reportedly results in better bowel function than does IPAA with mucosectomy. However, a potential cancer risk in the remnant mucosa has been observed. The clinical results of IPAA by double stapling technique (DS-IPAA) in which the anastomotic line was on the dentate line at posterior wall and the top of anal canal at anterior wall ("Partially intraanal canal anastomosis": PICA) to reduce the remnant mucosa were evaluated. METHODS Clinical results of PICA were retrospectively compared with those by DS-IPAA with anastomosis at above the anal canal on 1 year after open surgery. Of 211 UC cases that underwent DS-IPAA, 146 cases (69%) with PICA who were confirmed by the squamous epithelium on the posterior part of the distal donuts were included. Sixty-five cases with anastomosis above the anal canal were evaluated as the control. One stage surgery underwent in 95% of PICA and 93% of control. RESULTS One year after surgery, each group had six bowel movements daily. Nighttime evacuation was found in 16% of PICA and in 20% of control. Soiling was found in 1% of PICA and 4.8% of control. After one stage operation, anastomotic leakage that needed ileostomy was observed in 0.7% of PICA and 3% of control. CONCLUSION Partially intraanal canal anastomosis (PICA) can reduce anal canal mucosa with the same postoperative bowel function and complication rate as DS-IPAA above the anal canal. This procedure may be feasible for UC patients who can tolerate this procedure in terms of decreasing postoperative cancer risk.
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Affiliation(s)
- Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan.
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan
| | - Hirosuke Kuroki
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan
| | - Kyoko Yamada
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
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16
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Fukushima T, Nakajima K, Nozawa H, Nishino H, Sugita A, Koganei K, Futatsuki R, Yamaguchi S, Asano S, Matsushima M. [A case of Crohn's disease complicated by Guillain-Barrè syndrome during ustekinumab therapy]. Nihon Shokakibyo Gakkai Zasshi 2019; 116:324-329. [PMID: 30971669 DOI: 10.11405/nisshoshi.116.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We herein report a case involving a 23-year-old male patient with active Crohn's disease complicated by Guillain-Barrè syndrome during ustekinumab therapy. At age 11, the patient developed an anal fistula and was found to have multiple aphthae on the rectosigmoid colon, for which he was diagnosed with Crohn's disease. At age 12, he underwent gastrojejunal anastomosis for pyrolic stenosis. At age 20, a longitudinal ulcer was found on the ascending colon, and at age 21, aphthae were found on the stomach and efferent jejunum. At age 22, adalimumab was started, but the patient noted abdominal pain and diarrhea 4 months later. Hence, adalimumab was switched to ustekinumab (2017 June). Though ustekinumab was effective, the patient noted anorexia, weakness, and bilateral lower extremity numbness 1 year later (2018 June) and was admitted to the hospital. He was then diagnosed with Guillain-Barrè syndrome after spinal tap, neurological, and hematological examinations. Immunoglobulin therapy was provided but was less effective. The patient has since been receiving physical therapy. This has been the first report regarding Guillain-Barrè syndrome as a complication during ustekinumab therapy.
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Affiliation(s)
| | | | | | | | - Akira Sugita
- Department of IBD, Yokohama Municipal Citizen's Hospital
| | | | - Ryou Futatsuki
- Department of IBD, Yokohama Municipal Citizen's Hospital
| | | | - Shiori Asano
- Department of Neurology, Yokohama Municipal Citizen's Hospital
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17
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Higashiyama M, Sugita A, Koganei K, Wanatabe K, Yokoyama Y, Uchino M, Nagahori M, Naganuma M, Bamba S, Kato S, Takeuchi K, Omori T, Takagi T, Matsumoto S, Nagasaka M, Sagami S, Kitamura K, Katsurada T, Sugimoto K, Takatsu N, Saruta M, Sakurai T, Watanabe K, Nakamura S, Suzuki Y, Hokari R. Correction to: Management of elderly ulcerative colitis in Japan. J Gastroenterol 2019; 54:936-937. [PMID: 31392487 PMCID: PMC6759740 DOI: 10.1007/s00535-019-01606-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Management of elderly ulcerative colitis in Japan.
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Affiliation(s)
- Masaaki Higashiyama
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513 Japan
| | - Akira Sugita
- Inflammatory Bowel Disease Center, Yokohama Municipal Citizen’s Hospital, Yokohama, Kanagawa Japan
| | - Kazutaka Koganei
- Inflammatory Bowel Disease Center, Yokohama Municipal Citizen’s Hospital, Yokohama, Kanagawa Japan
| | - Kenji Wanatabe
- Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Yoko Yokoyama
- Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Motoi Uchino
- Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Masakazu Nagahori
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shigeki Bamba
- Division of Clinical Nutrition, Shiga University of Medical Science, Otsu, Shiga Japan
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Ken Takeuchi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Centre, Sakura, Chiba Japan
| | - Teppei Omori
- Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Tomohisa Takagi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Mitsuo Nagasaka
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Aichi Japan
| | - Shintaro Sagami
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Kazuya Kitamura
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa Japan
| | - Takehiko Katsurada
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido Japan
| | - Ken Sugimoto
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Japan
| | - Noritaka Takatsu
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiyuki Sakurai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Watanabe
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi Japan
| | - Shiro Nakamura
- Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Yasuo Suzuki
- Inflammatory Bowel Disease Center, Toho University Sakura Medical Centre, Sakura, Chiba Japan
| | - Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513 Japan
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18
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Higashiyama M, Sugita A, Koganei K, Wanatabe K, Yokoyama Y, Uchino M, Nagahori M, Naganuma M, Bamba S, Kato S, Takeuchi K, Omori T, Takagi T, Matsumoto S, Nagasaka M, Sagami S, Kitamura K, Katsurada T, Sugimoto K, Takatsu N, Saruta M, Sakurai T, Watanabe K, Nakamura S, Suzuki Y, Hokari R. Management of elderly ulcerative colitis in Japan. J Gastroenterol 2019; 54:571-586. [PMID: 31025187 PMCID: PMC6685935 DOI: 10.1007/s00535-019-01580-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/08/2019] [Indexed: 02/04/2023]
Abstract
Japan has the largest aging society, where many elderly people have intractable diseases including ulcerative colitis (UC). Along with the increasing total number of UC patients, the number of elderly UC patients has also been increasing and will continue to do so in the future. Although the clinical features and natural history of UC in the elderly have many similarities with UC in the non-elderly population, age-specific concerns including comorbidities, immunological dysfunction, and polypharmacy make the diagnosis and management of elderly UC challenging compared to UC in non-elderly patients. Based on increasing data related to elderly UC patients from Japan, as well as other countries, we reviewed the epidemiology, clinical course, differential diagnosis, management of comorbidities, surveillance, medical therapy, and surgery of UC in the elderly.
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Affiliation(s)
- Masaaki Higashiyama
- 0000 0004 0374 0880grid.416614.0Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513 Japan
| | - Akira Sugita
- 0000 0004 0377 5418grid.417366.1Inflammatory Bowel Disease Center, Yokohama Municipal Citizen’s Hospital, Yokohama, Kanagawa Japan
| | - Kazutaka Koganei
- 0000 0004 0377 5418grid.417366.1Inflammatory Bowel Disease Center, Yokohama Municipal Citizen’s Hospital, Yokohama, Kanagawa Japan
| | - Kenji Wanatabe
- 0000 0000 9142 153Xgrid.272264.7Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Yoko Yokoyama
- 0000 0000 9142 153Xgrid.272264.7Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Motoi Uchino
- 0000 0000 9142 153Xgrid.272264.7Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Masakazu Nagahori
- 0000 0001 1014 9130grid.265073.5Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Naganuma
- 0000 0004 1936 9959grid.26091.3cDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shigeki Bamba
- 0000 0000 9747 6806grid.410827.8Division of Clinical Nutrition, Shiga University of Medical Science, Otsu, Shiga Japan
| | - Shingo Kato
- 0000 0001 2216 2631grid.410802.fDepartment of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Ken Takeuchi
- 0000 0000 9290 9879grid.265050.4Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Centre, Sakura, Chiba Japan
| | - Teppei Omori
- 0000 0001 0720 6587grid.410818.4Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Tomohisa Takagi
- 0000 0001 0667 4960grid.272458.eMolecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satohiro Matsumoto
- 0000000123090000grid.410804.9Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Mitsuo Nagasaka
- 0000 0004 1761 798Xgrid.256115.4Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Aichi Japan
| | - Shintaro Sagami
- 0000 0004 1758 5965grid.415395.fCenter for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Kazuya Kitamura
- 0000 0004 0615 9100grid.412002.5Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa Japan
| | - Takehiko Katsurada
- 0000 0001 2173 7691grid.39158.36Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido Japan
| | - Ken Sugimoto
- grid.505613.4First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Japan
| | - Noritaka Takatsu
- grid.413918.6Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka Japan
| | - Masayuki Saruta
- 0000 0001 0661 2073grid.411898.dDivision of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiyuki Sakurai
- 0000 0001 0661 2073grid.411898.dDivision of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Watanabe
- 0000 0001 2248 6943grid.69566.3aDepartment of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi Japan
| | - Shiro Nakamura
- 0000 0000 9142 153Xgrid.272264.7Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Yasuo Suzuki
- 0000 0000 9290 9879grid.265050.4Inflammatory Bowel Disease Center, Toho University Sakura Medical Centre, Sakura, Chiba Japan
| | - Ryota Hokari
- 0000 0004 0374 0880grid.416614.0Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513 Japan
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19
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Kuroki H, Sugita A, Koganei K, Tatsumi K, Futatsuki R, Obara N, Arai K, Fukushima T. Crohn's disease manifesting as ileo-urachal fistula: Two cases reports and review of literatures. Int J Surg Case Rep 2018; 53:70-74. [PMID: 30390487 PMCID: PMC6215960 DOI: 10.1016/j.ijscr.2018.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/25/2018] [Accepted: 10/14/2018] [Indexed: 01/06/2023] Open
Abstract
Urachal tumor or umbilical discharge in Crohn’s disease are examined for internal fistula from diseased ileum to urachus. En broc resection with intestinal lesion and urachus is performed with successful outcome. Partial cystectomy is sometimes performed with urinary bladder inflamed.
Introduction: A fistula involving a patent urachus in a patient with Crohn’s disease is rare. Here we report ileourachal fistula formation in two patients with Crohn’ disease. Case presentations: The first patient was a 29-year-old man with Crohn’s disease and ileitis, and the second patient was a 43-year-old man with Crohn’s disease and ileitis. One of the patients showed pus/fecal discharge via the umbilicus. Both patients were eventually diagnosed with an ileourachal fistula associated with Crohn’s disease. In the first patient, the urachal remnant was connected to the urinary bladder and a Crohn’s disease-related intestinal lesion had formed a fistula to the urachus. In the second patient, a periumbilical inflammatory lesion extended to the bladder through the urachal remnant and to a longitudinal ulcer of the ileal lesion. The first patients underwent partial ileal resection, and partial cystectomy, while the second patient underwent urachal curettage, partial ileal resection, and partial cystectomy. In both. Conclusion: In cases of Crohn’s disease with an enterocutaneous fistula or pus discharge via the umbilicus, an examination to detect an urachal remnant with a fistula from the diseased intestine should be performed.
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Affiliation(s)
- Hirosuke Kuroki
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Akira Sugita
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Kazutaka Koganei
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Kenji Tatsumi
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Ryo Futatsuki
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Nao Obara
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Katsuhiko Arai
- Department of Surgery, Yokohama Municipal Citizen's Hospital, 240-8555 56, Okazawacho Hodogaya-ku, Yokohama City, Japan.
| | - Tsuneo Fukushima
- Matsushima Clinic, 220-0045 3-138 Isecho Nishi-ku, Yokohama City, Japan.
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20
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Ikeuchi H, Uchino M, Sugita A, Futami K, Fukushima K, Hata K, Koganei K, Kusunoki M, Uchida K, Nezu R, Kimura H, Takahashi K, Itabashi M, Kameyama H, Higashi D, Koyama F, Ueda T, Mizushima T, Suzuki Y. Long-term outcomes following restorative proctocolectomy ileal pouch-anal anastomosis in pediatric ulcerative colitis patients: Multicenter national study in Japan. Ann Gastroenterol Surg 2018; 2:428-433. [PMID: 30460346 PMCID: PMC6236100 DOI: 10.1002/ags3.12198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Few studies have investigated surgical outcomes following a colectomy in pediatric patients with ulcerative colitis (UC). PURPOSE This study aimed to determine long-term outcomes in a large cohort of pediatric patients who underwent proctocolectomy with ileal pouch-anal anastomosis (IPAA) for UC. METHODS Pediatric patients (<17 years old) who underwent surgery at 12 different hospitals in Japan between May 1979 and March 2015 were included in this study. Information was obtained by the use of a questionnaire survey. RESULTS There were 113 (53.3%) male and 99 (46.7%) female pediatric patients. The most common indication for elective surgery was failure of medical management, whereas emergency surgery was carried out for fulminant cases. A hand-sewn IPAA was used with a mucosectomy in 112 (52.8%), stapled anastomosis in 93 (43.9%), and not specified in 7 (3.3%) patients. Small bowel obstruction and surgical site infection were the most frequent early postoperative complications (POC), whereas pouchitis, small bowel obstruction, and perianal fistula were frequent late POC. The most common late POC was pouchitis, found in 38 (17.9%) of the patients, whereas pouch failure was noted in 11 patients at the latest follow-up examination. Cumulative pouch survival rate after 10 years was 91.7%. There were no significant differences regarding gender or anastomotic procedure in relation to cumulative pouch survival rate. CONCLUSION To avoid pouch failure following an IPAA procedure, it is important to recognize that pouchitis or an anal fistula may lead to this condition in pediatric UC patients.
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Affiliation(s)
- Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease SurgeryHyogo College of MedicineNishinomiyaHyogoJapan
| | - Motoi Uchino
- Department of Inflammatory Bowel Disease SurgeryHyogo College of MedicineNishinomiyaHyogoJapan
| | - Akira Sugita
- Department of Inflammatory Bowel DiseaseYokohama Municipal Citizen's HospitalYokohamaKanagawaJapan
| | - Kitaro Futami
- Department of SurgeryFukuoka University Chikushi HospitalChikushino, FukuokaJapan
| | - Kouhei Fukushima
- Department of Surgical and Molecular PathophysiologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Keisuke Hata
- Department of Surgical OncologyThe University of TokyoTokyoJapan
| | - Kazutaka Koganei
- Department of Inflammatory Bowel DiseaseYokohama Municipal Citizen's HospitalYokohamaKanagawaJapan
| | - Masato Kusunoki
- Department of Gastrointestinal and Pediatric SurgeryMie University Graduate School of MedicineTsuMieJapan
| | - Keiichi Uchida
- Department of Gastrointestinal and Pediatric SurgeryMie University Graduate School of MedicineTsuMieJapan
| | - Riichiro Nezu
- Department of SurgeryNishinomiya Municipal Center HospitalNishinomiyaHyogoJapan
| | - Hideaki Kimura
- Inflammatory Bowel Disease CenterYokohama City University Medical CenterYokohamaKanagawaJapan
| | | | - Michio Itabashi
- Institute of GastroenterologyTokyo Women's Medical University HospitalTokyoJapan
| | - Hitoshi Kameyama
- Division of Digestive and General SurgeryNiigata UniversityNiigataJapan
| | - Daijiro Higashi
- Department of SurgeryFukuoka University Chikushi HospitalChikushino, FukuokaJapan
| | - Fumikazu Koyama
- Department of SurgeryNara Medical UniversityKashihara, NaraJapan
| | - Takeshi Ueda
- Department of SurgeryNara Medical UniversityKashihara, NaraJapan
| | - Tsunekazu Mizushima
- Department of Therapeutics for Inflammatory Bowel DiseasesOsaka University Graduate School of MedicineSuita, OsakaJapan
| | - Yasuo Suzuki
- Department of Internal MedicineToho University Sakura Medical CenterSakuraChibaJapan
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21
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Uchino M, Ikeuchi H, Sugita A, Futami K, Watanabe T, Fukushima K, Tatsumi K, Koganei K, Kimura H, Hata K, Takahashi K, Watanabe K, Mizushima T, Funayama Y, Higashi D, Araki T, Kusunoki M, Ueda T, Koyama F, Itabashi M, Nezu R, Suzuki Y. Pouch functional outcomes after restorative proctocolectomy with ileal-pouch reconstruction in patients with ulcerative colitis: Japanese multi-center nationwide cohort study. J Gastroenterol 2018; 53:642-651. [PMID: 28884201 DOI: 10.1007/s00535-017-1389-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/31/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although several complications capable of causing pouch failure may develop after restorative proctocolectomy (RPC) for ulcerative colitis (UC), the incidences and causes are conflicting and vary according to country, race and institution. To avoid pouch failure, this study aimed to evaluate the rate of pouch failure and its risk factors in UC patients over the past decade via a nationwide cohort study. METHODS We conducted a retrospective, observational, multicenter study that included 13 institutions in Japan. Patients who underwent RPC between January 2005 and December 2014 were included. The characteristics and backgrounds of the patients before and during surgery and their postoperative courses and complications were reviewed. RESULTS A total of 2376 patients were evaluated over 6.7 ± 3.5 years of follow-up. Twenty-seven non-functional pouches were observed, and the functional pouch rate was 98.9% after RPC. Anastomotic leakage (odds ratio, 9.1) was selected as a risk factor for a non-functional pouch. The cumulative pouch failure rate was 4.2%/10 years. A change in diagnosis to Crohn's disease/indeterminate colitis (hazard ratio, 13.2) was identified as an independent risk factor for pouch failure. CONCLUSION The significant risk factor for a non-functional pouch was anastomotic leakage. The optimal staged surgical procedure should be selected according to a patient's condition to avoid anastomotic failure during RPC. Changes in diagnosis after RPC confer a substantial risk of pouch failure. Additional cohort studies are needed to obtain an understanding of the long-standing clinical course of and proper treatment for pouch failure.
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Affiliation(s)
- Motoi Uchino
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Kitaro Futami
- Department of Surgery, Fukuoka University Chikushi Hospital, Chikusino, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology and Vascular Surgery, The University of Tokyo, Tokyo, Japan
| | - Kouhei Fukushima
- Laboratory of Gastro Intestinal Tract Reconstruction, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | | | - Kazuhiro Watanabe
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tsunekazu Mizushima
- Department of Therapeutics for Inflammatory Bowel Diseases, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuji Funayama
- Department of Surgery, Sendai Red Cross Hospital, Sendai, Japan
| | - Daijiro Higashi
- Department of Surgery, Fukuoka University Chikushi Hospital, Chikusino, Japan
| | - Toshimitsu Araki
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masato Kusunoki
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takeshi Ueda
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Fumikazu Koyama
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Michio Itabashi
- Institute of Gastroenterology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Riichiro Nezu
- Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | - Yasuo Suzuki
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Japan
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22
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Matsuoka K, Kobayashi T, Ueno F, Matsui T, Hirai F, Inoue N, Kato J, Kobayashi K, Kobayashi K, Koganei K, Kunisaki R, Motoya S, Nagahori M, Nakase H, Omata F, Saruta M, Watanabe T, Tanaka T, Kanai T, Noguchi Y, Takahashi KI, Watanabe K, Hibi T, Suzuki Y, Watanabe M, Sugano K, Shimosegawa T. Evidence-based clinical practice guidelines for inflammatory bowel disease. J Gastroenterol 2018; 53:305-353. [PMID: 29429045 PMCID: PMC5847182 DOI: 10.1007/s00535-018-1439-1] [Citation(s) in RCA: 322] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic disorder involving mainly the intestinal tract, but possibly other gastrointestinal and extraintestinal organs. Although etiology is still uncertain, recent knowledge in pathogenesis has accumulated, and novel diagnostic and therapeutic modalities have become available for clinical use. Therefore, the previous guidelines were urged to be updated. In 2016, the Japanese Society of Gastroenterology revised the previous versions of evidence-based clinical practice guidelines for ulcerative colitis (UC) and Crohn's disease (CD) in Japanese. A total of 59 clinical questions for 9 categories (1. clinical features of IBD; 2. diagnosis; 3. general consideration in treatment; 4. therapeutic interventions for IBD; 5. treatment of UC; 6. treatment of CD; 7. extraintestinal complications; 8. cancer surveillance; 9. IBD in special situation) were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases. The guidelines were developed with the basic concept of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Recommendations were made using Delphi rounds. This English version was produced and edited based on the existing updated guidelines in Japanese.
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Affiliation(s)
- Katsuyoshi Matsuoka
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Taku Kobayashi
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Fumiaki Ueno
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan.
- Ofuna Central Hospital, 6-2-24 Ofuna, Kamakura-shi, Kanagawa, 247-0056, Japan.
| | - Toshiyuki Matsui
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Fumihito Hirai
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Nagamu Inoue
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Jun Kato
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kenji Kobayashi
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kiyonori Kobayashi
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kazutaka Koganei
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Reiko Kunisaki
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Satoshi Motoya
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Masakazu Nagahori
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Hiroshi Nakase
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Fumio Omata
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Masayuki Saruta
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshiaki Watanabe
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshiaki Tanaka
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Takanori Kanai
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yoshinori Noguchi
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Ken-Ichi Takahashi
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kenji Watanabe
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshifumi Hibi
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yasuo Suzuki
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Mamoru Watanabe
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kentaro Sugano
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Tooru Shimosegawa
- Guidelines Committee for Creating and Evaluating the ''Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease in Japan'', The Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
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23
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Kuroki H, Koganei K, Tatsumi K, Futatsuki R, Yamada K, Arai K, Obara N, Kimura H, Sugita A, Fukushima T. [Diagnosis and treatment of six patients with Crohn's disease complicated by recto-perineal-urethral fistula]. Nihon Shokakibyo Gakkai Zasshi 2018; 115:108-116. [PMID: 29353847 DOI: 10.11405/nisshoshi.115.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Recto-perineal-urethral fistula caused by Crohn's disease is a rare, for which fundamental treatment has not been established yet. We analyzed the clinical characteristics, diagnosis, treatment, and prognosis of six male patients with anorectal lesions caused by Crohn's disease. Three patients were treated with abdominoperineal resection and the other three with rectal excision without anastomosis. Excluding one case, which presented worsening immediately after surgery, symptoms of urethral fistula improved without urethral stenosis, dysuria, or sexual dysfunction. Recto-perineal-urethral fistula is currently treated with various treatment modalities, including colostomy and drug therapy. Although the evaluation of these modalities is required, abdominoperineal resection or rectal excision without anastomosis may be a valuable treatment option because these approaches improve the urethral fistula while sparing the urethra without any significant complications.
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Affiliation(s)
- Hirosuke Kuroki
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Kenji Tatsumi
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Ryo Futatsuki
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Kyoko Yamada
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Katsuhiko Arai
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Nao Obara
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center
| | - Akira Sugita
- Department of Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital
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24
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Koganei K, Tatsumi K, Futatsuki R. Surgical treatment for Crohn's disease. Nihon Rinsho 2017; 75:426-432. [PMID: 30566786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Surgery has important role in the management for Crohn's disease, although medical treatment had been developed in recent years. Surgical indications are as follows, massive bleeding, perforation, cancer, abscess, stenosis with obstruction, internal and external fistulas, severe anorectal disease, and medical failure. The principle of surgery is a minimal resection of intestine responsible for uncontrolled symptoms and repair of involved organs such as intestine, urinary bladder and abdominal wall. Strictureplasties are an effective alternative for stenosis which preserve the intestine. Seton treatment is often employed for complex perianal fistula. Surgery relieves the refractory symptoms well and should be employed at optimal time for the patients with severe symptoms which impaired their quality of lives.
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25
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Obara N, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Yamada K, Arai K, Sugita A, Hayashi H, Fukushima T. A case of Crohn's disease complicated with simultaneous double cancers of the small bowel. Nihon Shokakibyo Gakkai Zasshi 2016; 113:1901-1908. [PMID: 27829602 DOI: 10.11405/nisshoshi.113.1901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A case of Crohn's disease complicated with simultaneous double cancers of the small bowel is reported. The patient is a 66-year-old man who had suffered from Crohn's disease for 20 years. He underwent surgery to identify the source of repeated episodes of intestinal obstruction. Two short segments of strictures and proximal dilatations were found in the distal ileum. Therefore, we performed an en bloc resection of the two stenotic sections instead of strictureplasty. Histological examination of the resected specimen revealed not only Crohn's disease but also a well-differentiated adenocarcinoma within each of the two strictures. One had invaded to the muscular layer and the other to the subserosal layer. In cases of Crohn's disease with longstanding stenosis, the probability of carcinoma should be considered.
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Affiliation(s)
- Nao Obara
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital
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Sugita A, Koganei K, Tatsumi K, Futatsuki R, Kuroki H. [Epidemiology of colitis complicating cancer-postoperative cancer in ulcerative colitis and anorectal cancer in Crohn's disease]. Nihon Rinsho 2016; 74:1796-1801. [PMID: 30550684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Colitis complicating inflammatory bowel disease is gradually increasing in Japan. Although the postoperative cancer in ulcerative colitis is rare, careful postoperative follow up is nec- essary. Anorectal cancer including cancer of anal fistulae in Crohn's disease is the most common cancer in Japan and our original cancer surveillance program in which biopsy for anorectal lesion is performed for longstanding anal lesion (more than 10 years) is suggested to be effective for the detection of early cancer.
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Ohyama W, Yamaoka M, Yokoi K, Iwahashi M, Inage Y, Arihiro S, Koganei K, Sugita A, Ida H, Akiyama M. [Maternal Crohn's disease-related vitamin B12 deficient megaloblastic anemia in an infant]. Rinsho Ketsueki 2016; 57:15-9. [PMID: 26861098 DOI: 10.11406/rinketsu.57.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report an 11-month-old breast-fed boy with feeding difficulties, lethargy, and developmental delay. Blood examination showed pancytopenia and decreased serum levels of vitamin B12. Anisocytosis and poikilocytes were detected in his peripheral blood, and increased megaloblastosis without leukemic cells was detected in his bone marrow. After the diagnosis of megaloblastic anemia due to vitamin B12 deficiency, symptoms were improved by vitamin B12 administration. Further investigation of the mother identified Crohn's disease and suggested that the supply of vitamin B12 from the mother to the infant, via the placenta during pregnancy and via breast milk after birth, was decreased due to impaired absorption of vitamin B12 in the mother's small intestine. Magnetic resonance imaging of the boy's brain on admission showed cerebral cortex atrophy which had improved by the age of 1 year and 10 months after vitamin B12 treatment, though developmental delay was still evident at the age of 3 years. Infantile vitamin B12 deficiency often presents with nonspecific manifestations, such as developmental delay and failure to thrive, in addition to anemia and is thus not easily diagnosed. To prevent severe neurological sequelae, this condition must be rapidly diagnosed, because a prolonged duration increases the risk of permanent disabilities.
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Affiliation(s)
- Wataru Ohyama
- Department of Pediatrics, The Jikei University School of Medicine
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Kimura H, Kunisaki R, Tatsumi K, Koganei K, Sugita A, Endo I. Prolonged Medical Therapy Increases the Risk of Surgical Complications in Patients with Severe Ulcerative Colitis. Dig Surg 2016; 33:182-9. [PMID: 26859413 DOI: 10.1159/000442676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/22/2015] [Indexed: 12/10/2022]
Abstract
AIMS To determine the risk factors of surgical complications and the optimal timing of surgery for patients with severe ulcerative colitis (UC). METHODS One hundred one UC patients who had undergone surgery for a severe indication were retrospectively reviewed. Indications included severe disease unresponsive to medical therapy, massive bleeding, toxic megacolon, and colon perforation. Outcomes were compared based on the occurrence or absence of surgical complications. Patients with severe disease unresponsive to medical therapy were investigated separately to determine the optimal timing of surgery. RESULTS There was no significant difference regarding the use of rescue therapy. The duration of all medical therapy for a severe attack was the only significant factor associated with a surgical complication (p = 0.032). In patients with severe disease unresponsive to medical therapy, the receiver operating characteristic curve analysis showed that 30.5 days was the length of medical therapy after which the risk of surgical complications significantly increased. CONCLUSIONS In patients with severe UC, rescue therapy itself was not related to an increased risk of surgical complications. However, prolonged medical therapy increased the risk of surgical complications. Patients should undergo surgery within 30 days from the institution of medical therapy for a severe attack.
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Affiliation(s)
- Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
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29
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Koganei K, Sugita A. [STRICTUREPLASTY FOR STENOTIC LESION OF CROHN'S DISEASE]. Nihon Geka Gakkai Zasshi 2015; 116:183-184. [PMID: 26281661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Sugita A, Koganei K, Tatsumi K, Futatsuki R, Kuroki H, Yamada K, Arai K, Fukushima T. [Recent advances in medical and surgical treatment of ulcerative colitis]. Nihon Geka Gakkai Zasshi 2015; 116:99-103. [PMID: 26050509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Recent advances in both medical and surgical treatment of ulcerative colitis have been remarkable. Changes in medical treatment are mainly good results of therapy with the anti-TNF-α antibody, tacrolimus, and those in surgical treatment are an expansion of the surgical indications to include patients with intractable disease, such as treatment refractoriness and chronic corticosteroid dependence, by a better postoperative clinical course after pouch surgery, improred selection of surgical procedures and the timing of surgery in elderly patients. To offer the optimal treatment for patients with ulcerative colitis, new medical therapies should be analyzed from the standpoint of the efficacy and limitations of effect. Long postoperative clinical course of surgical patients including colitic cancer, prevention of postoperative complications should be also analyzed.
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Mizuno S, Mikami Y, Kamada N, Handa T, Hayashi A, Sato T, Matsuoka K, Matano M, Ohta Y, Sugita A, Koganei K, Sahara R, Takazoe M, Hisamatsu T, Kanai T. Cross-talk between RORγt+ innate lymphoid cells and intestinal macrophages induces mucosal IL-22 production in Crohn's disease. Inflamm Bowel Dis 2014; 20:1426-34. [PMID: 24991784 DOI: 10.1097/mib.0000000000000105] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Interleukin (IL)-22-producing RORγt innate lymphoid cells (ILCs) play a pivotal role in intestinal immunity. Recent reports demonstrated that ILCs contribute to mucosal protection and intestinal inflammation in mice. In humans, numbers of RORγt ILCs are significantly increased in the intestine of patients with Crohn's disease (CD), suggesting that ILCs may be associated with intestinal inflammation in CD. However, the mechanism by which ILCs are regulated in the intestine of patients with CD is poorly understood. This study aimed to determine the activation mechanism of intestinal ILCs in patients with CD. METHODS CD45 lineage marker ILCs were isolated from intestinal lamina propria of patients with CD. ILCs were then subdivided into 4 distinct populations based on the expression of CD56 and CD127. Purified ILC subsets were cocultured with intestinal CD14 macrophages, and IL-22 production was evaluated. RESULTS CD127CD56 and CD127CD56 ILC, but not CD127CD56 or CD127CD56 ILC, subsets expressed RORγt and produced IL-22. IL-22 production by these ILC subsets was enhanced when ILCs were cocultured with intestinal macrophages. IL-23 or cell-to-cell contact was required for macrophage-mediated activation of ILCs. IL-22 production by ILCs was perturbed in inflamed mucosa compared with noninflamed mucosa. IL-22 induced the expression of Reg1α and Claudin-1 in human intestinal epithelial organoids. CONCLUSIONS RORγt ILCs might enhance mucosal barrier function through the upregulation of Reg1α through production of IL-22. Although CD14 macrophages augment intestinal inflammation in patients with CD, macrophages also promote a negative feedback pathway through the activation of IL-22 production by RORγt ILCs.
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Affiliation(s)
- Shinta Mizuno
- *Department of Gastroenterology and Hepatology, and †Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan; ‡Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan; §Life Science of Medical Bio Science, Waseda University School of Advanced Science and Engineering, Tokyo, Japan; ‖Department of Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan; and ¶Coloproctology Center of Social Health Insurance Medical Center, Tokyo, Japan
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Uo M, Hisamatsu T, Miyoshi J, Kaito D, Yoneno K, Kitazume MT, Mori M, Sugita A, Koganei K, Matsuoka K, Kanai T, Hibi T. Mucosal CXCR4+ IgG plasma cells contribute to the pathogenesis of human ulcerative colitis through FcγR-mediated CD14 macrophage activation. Gut 2013; 62:1734-44. [PMID: 23013725 DOI: 10.1136/gutjnl-2012-303063] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Chronic inflammation characterised by IgG-producing plasma cell infiltration of colonic mucosa is a histological hallmark of ulcerative colitis (UC); however, whether its function is pathogenic or protective remains unclear. OBJECTIVE To explore the contribution of intestinal IgG plasma cells to UC pathogenesis. METHODS We isolated lamina propria mononuclear cells (LPMCs) from intestinal mucosa of UC patients and analysed the characteristics of intestinal plasma cells (expression profiles of differentiation molecules and chemokine receptors). We investigated the involvement of IgG-immune complex (IC)-Fc gamma receptor (FcγR) signalling in intestinal inflammation by examining the cytokine production by LPMCs in response to IgG-IC stimulation. RESULTS IgG plasma cells that were markedly increased in number in the inflamed mucosa of UC patients showed a distinct expression profile (CD19(+)CD27(low), CCR10(low)CXCR4(high)) compared with IgA plasma cells (CD19(+/-)CD27(high), CCR10(high)CXCR4(-/low)). In vitro IgG-IC stimulation activated intestinal CD14 macrophages that were increased in number in the inflamed mucosa of UC patients via FcγRI and FcγRII, and induced the extensive production of pro-inflammatory cytokines such as tumour necrosis factor (TNF) and interleukin-1β (IL-1β), comparable to the effect of commensal bacteria stimulation. Co-stimulation with IgG-IC and commensal bacteria increased TNF and IL-1β production more than stimulation with the latter alone. Furthermore, IgG-IC notably up-regulated the expression of TL1A, whereas commensal bacteria specifically induced IL-23. CONCLUSIONS Collectively, these results demonstrate a novel aspect of UC pathogenesis in which unique IgG plasma cells infiltrate the inflamed mucosa via CXCR4, and critically influence UC pathogenesis by exacerbating mucosal inflammation through the activation of 'pathogenic' intestinal CD14 macrophages via IgG-IC-FcγR signalling.
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Affiliation(s)
- Michihide Uo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Tatsumi K, Sugita A, Koganei K, Futatsuki R, Kuroki H, Yamada K, Nakao S, Sako M, Kimura H, Arai K, Fukushima T. [Long-term outcomes of ileal pouch-anal canal anastomosis in children with ulcerative colitis]. Nihon Shokakibyo Gakkai Zasshi 2013; 110:2081-2088. [PMID: 24305096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The present study investigated the long-term outcomes of restorative proctocolectomy in pediatric patients with ulcerative colitis (UC). We report a series of 25 patients who underwent total proctocolectomy with ileal pouch-anal canal anastomosis (IACA). Surgery was performed for medically intractable colitis and severe colitis in 14 and 11 patients, respectively. Early and late complications were observed in 6 (24%) and 14 (56%) patients, respectively. The long-term quality of life outcomes were satisfactory, including both bowel function and social function. Growth retardation was observed in 6 patients. Five patients exhibited catch-up growth and 3 patients overcame growth retardation. Patients with growth retardation tended to have a younger onset and longer duration of UC, as well as a longer duration and higher total dose of steroid use. In conclusion, the long-term outcomes of pediatric patients with UC undergoing IACA are satisfactory. Furthermore, to minimize the risk of growth retardation, surgery should be performed without delay.
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Affiliation(s)
- Kenji Tatsumi
- Department of Surgery, Yokohama Municipal Citizen's Hospital
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34
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Yoneno K, Hisamatsu T, Shimamura K, Kamada N, Ichikawa R, Kitazume MT, Mori M, Uo M, Namikawa Y, Matsuoka K, Sato T, Koganei K, Sugita A, Kanai T, Hibi T. TGR5 signalling inhibits the production of pro-inflammatory cytokines by in vitro differentiated inflammatory and intestinal macrophages in Crohn's disease. Immunology 2013; 139:19-29. [PMID: 23566200 PMCID: PMC3634536 DOI: 10.1111/imm.12045] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 10/30/2012] [Accepted: 11/05/2012] [Indexed: 12/13/2022] Open
Abstract
Bile acids (BAs) play important roles not only in lipid metabolism, but also in signal transduction. TGR5, a transmembrane receptor of BAs, is an immunomodulative factor, but its detailed mechanism remains unclear. Here, we aimed to delineate how BAs operate in immunological responses via the TGR5 pathway in human mononuclear cell lineages. We examined TGR5 expression in human peripheral blood monocytes, several types of in vitro differentiated macrophages (Mϕs) and dendritic cells. Mϕs differentiated with macrophage colony-stimulating factor and interferon-γ (Mγ-Mϕs), which are similar to the human intestinal lamina propria CD14+ Mϕs that contribute to Crohn's disease (CD) pathogenesis by production of pro-inflammatory cytokines, highly expressed TGR5 compared with any other type of differentiated Mϕ and dendritic cells. We also showed that a TGR5 agonist and two types of BAs, deoxycholic acid and lithocholic acid, could inhibit tumour necrosis factor-α production in Mγ-Mϕs stimulated by commensal bacterial antigen or lipopolysaccharide. This inhibitory effect was mediated by the TGR5–cAMP pathway to induce phosphorylation of c-Fos that regulated nuclear factor-κB p65 activation. Next, we analysed TGR5 levels in lamina propria mononuclear cells (LPMCs) obtained from the intestinal mucosa of patients with CD. Compared with non-inflammatory bowel disease, inflamed CD LPMCs contained more TGR5 transcripts. Among LPMCs, isolated CD14+ intestinal Mϕs from patients with CD expressed TGR5. In isolated intestinal CD14+ Mϕs, a TGR5 agonist could inhibit tumour necrosis factor-α production. These results indicate that TGR5 signalling may have the potential to modulate immune responses in inflammatory bowel disease.
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Affiliation(s)
- Kazuaki Yoneno
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
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Miyake M, Toguchi H, Nishibayashi T, Higaki K, Sugita A, Koganei K, Kamada N, Kitazume MT, Hisamatsu T, Sato T, Okamoto S, Kanai T, Hibi T. Establishment of novel prediction system of intestinal absorption in humans using human intestinal tissues. J Pharm Sci 2013; 102:2564-71. [PMID: 23686795 DOI: 10.1002/jps.23609] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/14/2013] [Accepted: 04/17/2013] [Indexed: 12/19/2022]
Abstract
The objective of this study was to establish a novel prediction system of drug absorption in humans by utilizing human intestinal tissues. Based on the transport index (TI), a newly defined parameter, calculated by taking account of the change in drug concentrations because of precipitation on the apical side and the amounts accumulated in the tissue and transported to the basal side, the absorbability of drugs in rank order as well as the fraction of dose absorbed (Fa) in humans were estimated. Human intestinal tissues taken from ulcerative colitis or Crohn's disease patients were mounted in a mini-Ussing chamber and transport studies were performed to evaluate the permeation of drugs, including FD-4, a very low permeable marker, atenolol, a low permeable marker, and metoprolol, a high permeable marker. Although apparent permeability coefficients calculated by the conventional equation did not reflect human Fa values for FD-4, atenolol, and metoprolol, TI values were well correlated with Fa values, which are described by 100 · [1 - e (- f · (TI - α)) ]. Based on this equation, Fa values in humans for other test drugs were predicted successfully, indicating that our new system utilizing human intestinal tissues would be valuable for predicting oral drug absorption in humans.
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Affiliation(s)
- Masateru Miyake
- Division of Gastroenterology, Department of Internal Medicine Keio University School of Medicine, Shinanomachi 35 Shinjyuku-ku, Tokyo 160-8582, Japan.
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Sugita A, Koganei K, Tatsumi K, Yamada K, Futatsuki R, Kuroki H, Kimura H, Kitou F, Fukushima T. [Management of rectal cancer including cancer in the anal fistula with Crohn's disease]. Nihon Shokakibyo Gakkai Zasshi 2013; 110:396-402. [PMID: 23459533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Akira Sugita
- Department of Surgery, Yokohama Municipal Hospital, Japan.
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Koganei K, Sugita A, Tatsumi K, Futatsuki R, Kimura H. [Clinical course and complications of fecal diversion for the patients with Crohn's disease]. Nihon Rinsho 2012; 70 Suppl 1:443-451. [PMID: 23126133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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38
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Koganei K, Sugita A, Tatsumi K, Futatsuki R, Kimura H. [Anorectal lesions in inflammatory bowel disease]. Nihon Rinsho 2012; 70 Suppl 1:253-260. [PMID: 23126100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Hayashi H, Miyagi Y, Sekiyama A, Yoshida S, Nakao S, Okamoto N, Koganei K, Sugita A. Colorectal small cell carcinoma in ulcerative colitis with identical rare p53 gene mutation to associated adenocarcinoma and dysplasia. J Crohns Colitis 2012; 6:112-5. [PMID: 22261536 DOI: 10.1016/j.crohns.2011.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 08/09/2011] [Accepted: 08/11/2011] [Indexed: 02/07/2023]
Abstract
Colorectal small cell carcinomas (SCCs) are rare tumors and are infrequently associated with ulcerative colitis (UC). We report a case of primary rectal SCC combined with adenocarcinoma arising in left-sided UC. Immunohistochemically, tumor cells were positive for chromogranin A, synaptophysin, and CD56 in the SCC but not in the adenocarcinoma. The patient simultaneously developed multiple lesions of adenocarcinoma and high-grade dysplasia in the sigmoid colon and rectum. To elucidate whether SCC might evolve from multipotential cells in dysplasia and/or adenocarcinoma, we examined the mutational status of TP53 and KRAS. The same clonality of these lesions including SCC was confirmed by the presence of an identical single nucleotide point mutation in TP53. KRAS mutation was not observed in these lesions. Thus, these lesions seem to have developed from the same origin. Long-standing inflammation leading to dysplasia might be responsible for the development of some SCCs in UC particularly when they are combined with dysplasia and/or adenocarcinoma.
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Affiliation(s)
- Hiroyuki Hayashi
- Department of Pathology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama 240-8555, Japan.
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Sugita A, Koganei K, Tatsumi K, Futatsuki R, Kimura H. [Strategy of surgical treatment for inflammatory bowel disease]. Nihon Rinsho 2012; 70 Suppl 1:413-419. [PMID: 23126128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Akira Sugita
- Department of Surgery, Yokohama Municipal Hospital
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Yabushita Y, Kimura H, Yamamoto H, Ue N, Kunisaki R, Sasaki T, Koganei K, Sugita A, Fukushima T, Endo I. A Case of Ileo-ovarian Fistula in Crohn's Disease. ACTA ACUST UNITED AC 2012. [DOI: 10.5833/jjgs.45.340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sugita A, Ikeuchi H, Funayama Y, Kimura H, Iiai T, Futami K, Itabashi M, Koganei K, Sasaki I, Watanabe M. [Long-term function and quality of life after surgical treatments for ulcerative colitis - multicenter analysis for surgical patients with more than 5 years follow up]. Nihon Shokakibyo Gakkai Zasshi 2011; 108:1996-2002. [PMID: 22139486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Akira Sugita
- Department of Surgery, Yokohama Municipal Hospital.
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Sugita A, Koganei K, Kimura H. [Strategy for early detection of colitic cancer]. Nihon Rinsho 2011; 69 Suppl 3:284-289. [PMID: 22213971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Akira Sugita
- Department of Surgery, Yokohama Municipal Hospital
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Takayama T, Kamada N, Chinen H, Okamoto S, Kitazume MT, Chang J, Matuzaki Y, Suzuki S, Sugita A, Koganei K, Hisamatsu T, Kanai T, Hibi T. Imbalance of NKp44(+)NKp46(-) and NKp44(-)NKp46(+) natural killer cells in the intestinal mucosa of patients with Crohn's disease. Gastroenterology 2010; 139:882-92, 892.e1-3. [PMID: 20638936 DOI: 10.1053/j.gastro.2010.05.040] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 04/30/2010] [Accepted: 05/20/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Mucosal natural killer (NK) cells that produce interleukin (IL)-22 mediate intestinal homeostasis and inflammation in mice. However, their role in the pathogenesis of human inflammatory bowel diseases (IBDs) is not known. We investigated intestinal NK cells in intestinal mucosa samples of patients with Crohn's disease (CD). METHODS We isolated lamina propria NK cells from intestinal mucosal samples of patients with IBD and subjects without IBD (controls) and analyzed expression patterns of cell surface molecules and cytokine production. Interactions between lamina propria NK cells and intestinal macrophages were examined. RESULTS In intestinal mucosa samples from controls, NKp44 and NKp46 were expressed differentially on CD3(-)CD56(+) NK cells, NKp44(+)NKp46(-) (NKp44(+)) NK cells expressed CD127 and the transcription factor retinoic acid-related orphan receptor C (RORC) and produced IL-22 whereas NKp44(-)NKp46(+) (NKp46(+)) NK cells did not express CD127 or RORC and produced interferon (IFN)-gamma. NKp46(+) NK cells were predominant in intestinal mucosa of patients with CD compared with controls or patients with ulcerative colitis. Upon interaction with intestinal inflammatory macrophages NKp46(+), NK cells from patients with CD were activated via IL-23 and produced IFN-gamma; this activation required cell-to-cell contact. CONCLUSIONS The balance of NKp44(+)/NKp46(+) NK cells is disrupted in intestinal mucosa of patients with CD. NKp46(+) NK cells might mediate the pathogenesis of CD by producing IFN-gamma.
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Affiliation(s)
- Tetsuro Takayama
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Kamada N, Hisamatsu T, Honda H, Kobayashi T, Chinen H, Takayama T, Kitazume MT, Okamoto S, Koganei K, Sugita A, Kanai T, Hibi T. TL1A produced by lamina propria macrophages induces Th1 and Th17 immune responses in cooperation with IL-23 in patients with Crohn's disease. Inflamm Bowel Dis 2010; 16:568-75. [PMID: 19834969 DOI: 10.1002/ibd.21124] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Tumor necrosis factor (TNF)-like protein 1A (TL1A) is a member of the TNF superfamily and contributes to the pathogenesis of Crohn's disease (CD) by stimulating T-helper (Th) 1 cells. In addition to Th1, recent studies have focused on the role of Th17 cells in the pathogenesis of CD. Here we tried to clarify the role of TL1A in Th1 and Th17 immunity in CD. METHODS TL1A expression was assessed by quantitative reverse-transcription polymerase chain reaction (RT-PCR) in lamina propria (LP) macrophages (LP-M phi s) from normal controls (NC) and patients with CD or ulcerative colitis (UC). Purified LP CD4(+) T cells were stimulated with TL1A and/or IL-23 and interferon gamma (IFN-gamma) and interleukin (IL)-17 levels were analyzed. We also examined the effect of TL1A on naïve CD4(+) T-cell differentiation. RESULTS We found that LP-M phi s are a major producer of TL1A. TL1A expression was markedly enhanced in LP-M phi s from CD patients compared with NC or UC patients. IL-23, in addition to TL1A, was induced in LP-M phi s by commensal bacteria stimulation. TL1A and IL-23 synergistically promoted the production of IFN-gamma and IL-17 by LP T cells, while TL1A alone did not induce cytokine production. Furthermore, TL1A promoted Th17 differentiation from naïve T cells by LP-M phi s; however, IL-23 did not show any synergistic effects on Th17 differentiation. CONCLUSIONS TL1A expressed in LP-M phi s might play an important role in the pathogenesis of CD by inducing Th1 and Th17 immunity. IL-23 differentially regulated these functions of TL1A on memory and naïve T cells.
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Affiliation(s)
- Nobuhiko Kamada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Kamada N, Hisamatsu T, Honda H, Kobayashi T, Chinen H, Kitazume MT, Takayama T, Okamoto S, Koganei K, Sugita A, Kanai T, Hibi T. Human CD14+ macrophages in intestinal lamina propria exhibit potent antigen-presenting ability. J Immunol 2009; 183:1724-31. [PMID: 19592647 DOI: 10.4049/jimmunol.0804369] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Intestinal APCs are considered critical in maintaining the balance between the response against harmful pathogens and the induction of tolerance to commensal bacteria and food Ags. Recently, several studies indicated the presence of gut-specific APC subsets, which possess both macrophage and dendritic cell (DC) markers. These unique APC subsets play important roles in gut immunity, especially for immune regulation against commensal bacteria. Herein, we examined a unique macrophage subset, which coexpressed the macrophage (Mphi) marker CD14 and the DC marker CD209 in human intestinal lamina propria (LP). The LP Mphi subset in both normal control subjects or Crohn's disease (CD) patients induced proliferation of naive CD4(+) T cells as well as monocyte-derived DCs, and it expressed retinoic acid synthetic enzyme retinaldehyde dehydrogenase 2 and retinol dehydrogenase 10, which induced expression of gut homing receptors on T cells in a retinoic acid-dependent manner. Moreover, the LP Mphi subset strongly evoked differentiation of Th1 cells and slightly induced Th17 cells in both normal control subjects and CD patients; the inducing potential was highest in CD patients. In CD patients, Th17, but not Th1, induction by the LP Mphi subset was enhanced in the presence of commensal bacteria Ags. This enhancement was not observed in normal control subjects. The Th17 induction by the LP Mphi subset was inhibited by neutralization of IL-6 and IL-1beta, but it was enhanced by blockade of retinoic acid signaling. These observations highlight a role for LP Mphi in the enhanced Th1, and potentially in Th17 differentiation, at the inflammatory site of inflammatory bowel diseases.
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Affiliation(s)
- Nobuhiko Kamada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Funayama Y, Fukushima K, Takahashi S, Suzuki Y, Koganei K, Hirai F, Moroi R. Interface of surgery and internal medicine in the treatment of ulcerative colitis: discussion. Nihon Shokakibyo Gakkai Zasshi 2009; 106:1011-1025. [PMID: 19578309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Kobayashi T, Okamoto S, Hisamatsu T, Kamada N, Chinen H, Saito R, Kitazume MT, Nakazawa A, Sugita A, Koganei K, Isobe K, Hibi T. IL23 differentially regulates the Th1/Th17 balance in ulcerative colitis and Crohn's disease. Gut 2008; 57:1682-9. [PMID: 18653729 DOI: 10.1136/gut.2007.135053] [Citation(s) in RCA: 417] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A novel T helper (Th) cell lineage, Th17, that exclusively produces the proinflammatory cytokine interleukin 17 (IL17) has been reported to play important roles in various inflammatory diseases. IL23 is also focused upon for its potential to promote Th17. Here, the roles of the IL23/IL17 axis in inflammatory bowel diseases such as ulcerative colitis (UC) and Crohn's disease (CD) were investigated. METHODS Mucosal samples were obtained from surgically resected specimens (controls, n = 12; UC, n = 17; CD, n = 22). IL17 production by isolated peripheral blood (PB) and lamina propria (LP) CD4(+) cells was examined. Quantitative PCR amplification was performed to determine the mRNA expression levels of IL17, interferon gamma (IFNgamma), IL23 receptor (IL23R) and retinoic acid-related orphan receptor gamma (RORC) in LP CD4(+) cells, and IL12 family members, such as IL12p40, IL12p35 and IL23p19, in whole mucosal specimens. The effects of exogenous IL23 on IL17 production by LP CD4(+) cells were also examined. RESULTS IL17 production was higher in LP CD4(+) cells than in PB. Significant IL17 mRNA upregulation in LP CD4(+) cells was found in UC, while IFNgamma was increased in CD. IL23R and RORC were upregulated in LP CD4(+) cells isolated from both UC and CD. IL17 production was significantly increased by IL23 in LP CD4(+) cells from UC but not CD. Upregulated IL23p19 mRNA expression was correlated with IL17 in UC and IFNgamma in CD. CONCLUSIONS IL23 may play important roles in controlling the differential Th1/Th17 balance in both UC and CD, although Th17 cells may exist in both diseases.
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Affiliation(s)
- T Kobayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Sugita A, Koganei K, Kimura H, Yamada K, Futatuki R, Kitoh F, Fukushima T. [Reconstruction of proctocolectomy: which is the best surgical procedure?]. Nihon Geka Gakkai Zasshi 2008; 109:269-273. [PMID: 18939461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Total proctocolectomy is commonly performed in patients with ulcerative colitis or familial adenomatosis coli. The standard surgical procedure for reconstruction is the ileal pouch anal anastomosis with rectal mucosal stripping (IPAA), which is radical treatment for the disease, or stapled ileal pouch anal anastomosis with preserved anal canal (stapled IPAA), which results in a lower incidence of soiling with a high possibility of one-stage surgery. Postoperative cancer surveillance colonoscopy is recommended in patients with stapled IPAA, and patients with IPAA have also at risk for cancer in the anastomotic site, although at very low incidence. Quality of life (QOL) studies (SF36, etc.) found good QOL after surgery in patients who underwent both procedures. Patients with permanent ileostomy for preoperative anal dysfunction also had good QOL. The surgical procedure for reconstruction should be determined based on surgical indications, preoperative anal function, and patient's request. For improved QOL in the future, pouch surgery should have a lower incidence of diverting ileostomy and result in fewer bowel movements and a lower incidence of soiling, with optimal management of pouchitis.
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Affiliation(s)
- Akira Sugita
- Department of Surgery, Yokohama Municipal Hospital, Yokohama, Japan
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Kamada N, Hisamatsu T, Okamoto S, Chinen H, Kobayashi T, Sato T, Sakuraba A, Kitazume MT, Sugita A, Koganei K, Akagawa KS, Hibi T. Unique CD14 intestinal macrophages contribute to the pathogenesis of Crohn disease via IL-23/IFN-gamma axis. J Clin Invest 2008; 118:2269-80. [PMID: 18497880 DOI: 10.1172/jci34610] [Citation(s) in RCA: 311] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Accepted: 04/09/2008] [Indexed: 02/06/2023] Open
Abstract
Intestinal macrophages play a central role in regulation of immune responses against commensal bacteria. In general, intestinal macrophages lack the expression of innate-immune receptor CD14 and do not produce proinflammatory cytokines against commensal bacteria. In this study, we identified what we believe to be a unique macrophage subset in human intestine. This subset expressed both macrophage (CD14, CD33, CD68) and DC markers (CD205, CD209) and produced larger amounts of proinflammatory cytokines, such as IL-23, TNF-alpha, and IL-6, than typical intestinal resident macrophages (CD14-CD33+ macrophages). In patients with Crohn disease (CD), the number of these CD14+ macrophages were significantly increased compared with normal control subjects. In addition to increased numbers of cells, these cells also produced larger amounts of IL-23 and TNF-alpha compared with those in normal controls or patients with ulcerative colitis. In addition, the CD14+ macrophages contributed to IFN-gamma production rather than IL-17 production by lamina propria mononuclear cells (LPMCs) dependent on IL-23 and TNF-alpha. Furthermore, the IFN-gamma produced by LPMCs triggered further abnormal macrophage differentiation with an IL-23-hyperproducing phenotype. Collectively, these data suggest that this IL-23/IFN-gamma-positive feedback loop induced by abnormal intestinal macrophages contributes to the pathogenesis of chronic intestinal inflammation in patients with CD.
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Affiliation(s)
- Nobuhiko Kamada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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