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Clinical Journal of Gastroenterology

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https://www.readbyqxmd.com/read/29159718/genetics-and-epigenetics-in-the-pathogenesis-of-primary-biliary-cholangitis
#1
REVIEW
Satoru Joshita, Takeji Umemura, Eiji Tanaka, Masao Ota
Primary biliary cholangitis (PBC) is a chronic, slowly progressive cholestatic autoimmune liver disease predominantly afflicting women. PBC is characterized by the presence of disease-specific antimitochondrial antibodies and the histological destruction of intrahepatic bile ducts, which eventually lead to cirrhosis and hepatic failure. Fortunately, ursodeoxycholic acid therapy has improved the outcome of the vast majority of PBC cases. Although the etiology of PBC has not yet been elucidated, human leukocyte antigen (HLA) class II alleles have been consistently associated with disease onset for decades...
November 20, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29143914/sclerosing-mesenteritis-diagnosed-with-computed-tomography-and-ultrasound-guided-needle-biopsy-the-utility-of-the-coaxial-technique
#2
Masayuki Ueno, Naoyuki Nishimura, Yuichi Shimodate, Akira Doi, Hirokazu Mouri, Kazuhiro Matsueda, Hiroshi Yamamoto, Motowo Mizuno
Here we report a case of sclerosing mesenteritis that we diagnosed with needle biopsy under the guidance of computed tomography (CT) and ultrasound (US) observation. An 82-year-old woman presented with appetite loss, weight loss and epigastric pain. CT of the abdomen and pelvis revealed increased density of the mesentery adjacent to the small bowel and enlarged lymph nodes. Sclerosing mesenteritis was suspected, but malignancies, such as lymphoma, were also considered. We performed CT and US-guided needle biopsy with the coaxial technique...
November 16, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29124648/a-case-of-esophageal-actinomycosis-with-a-unique-morphology-presenting-as-a-refractory-ulcer
#3
Sho Fukuda, Noboru Watanabe, Takahiro Domen, Mitsuaki Ishioka, Masayuki Sawaguchi, Reina Ohba, Hisashi Shiga, Tamotsu Matsuhashi, Mario Jin, Katsunori Iijima
A 60-year-old man presented with odynophagia after bronchial artery infusion chemotherapy for pulmonary metastasis of hepatocellular carcinoma. Esophagogastroduodenoscopy (EGD) revealed an esophageal ulcer in the middle thoracic esophagus. An esophageal biopsy demonstrated no malignancy. However, the symptoms had not improved after a month. EGD was performed again and showed a white cord lump at the bottom of the same esophageal ulcer identified before, showing no improving tendency. A repeated biopsy of the lump revealed actinomycosis, and the symptoms were improved by the oral administration of ampicillin...
November 9, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29116626/unclassified-hepatocellular-adenoma-in-a-middle-aged-woman-with-glucose-intolerance
#4
Kumi Ozaki, Kenichi Harada, Toru Yamamoto, Hiroyuki Aoyagi, Yasuharu Kaizaki, Jun Yoshikawa
The patient was a 43-year-old woman with obesity (body mass index: 29.1) and glucose intolerance who was not taking oral contraceptives. An ultrasound showed a hypoechoic hepatic mass. Dynamic contrast-enhanced computed tomography revealed a lesion in segment 6 that showed homogeneous and slight-to-moderate enhancement in the arterial phase with persistent enhancement during the portal and equilibrium phases. On magnetic resonance (MR) imaging, the lesion demonstrated hyperintensity on T2- and diffusion-weighted images and hypointensity in the hepatobiliary phase of gadoxetic-acid-enhanced MR imaging...
November 7, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29094324/a-caucasian-american-patient-with-celiac-disease-diagnosed-in-japan-and-successfully-treated-with-a-gluten-free-diet
#5
Haruka Wada, Mari Hayashida, Taro Sato, Shintaro Minowa, Osamu Ikezaki, Tatsuya Mitsui, Miki Miura, Yoshihiko Ohmori, Daisuke Saito, Akihito Sakuraba, Hideo Kamiichi, Kengo Tokunaga, Makoto Mochizuki, Junji Shibahara, Hideaki Mori, Tadakazu Hisamatsu
We report the case of a 33-year-old Caucasian American man diagnosed with celiac disease in Japan. He presented to a community hospital because of chronic watery diarrhea and weight loss for 6 months. The laboratory data showed low serum albumin and serum cholesterol. A colonoscopy was normal. He was referred to our hospital for further work-up. Serum tissue transglutaminase immunoglobulin A (IgA) and endomysial antibody were positive. The HLA type was DQ2. Esophagogastroduodenoscopy (EGD) revealed nodular and mosaic-patterned mucosa from the bulb to the second part of the duodenum...
November 1, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29094323/enormous-postoperative-perforation-after-endoscopic-submucosal-dissection-for-duodenal-cancer-successfully-treated-with-filling-and-shielding-by-polyglycolic-acid-sheets-with-fibrin-glue-and-computed-tomography-guided-abscess-puncture
#6
Yoshiko Ohara, Kengo Takimoto, Takashi Toyonaga, Tomohiro Yamaguchi, Hiroya Sakaguchi, Fumiaki Kawara, Shinwa Tanaka, Tsukasa Ishida, Yoshinori Morita, Eiji Umegaki
A female in her 70s underwent esophagogastroduodenoscopy (EGD) for screening, and a 0-IIa lesion measuring approximately 15 mm was detected in the descending portion of the duodenum. Due to the malignant potency of the lesion, endoscopic submucosal dissection (ESD) was performed. Microperforation occurred during ESD. The lesion was removed en bloc and the post-ESD ulcer bed was closed with clips. The next day, the patient had abdominal pain and computed tomography (CT) revealed a small amount of free air in the retroperitoneal space...
November 1, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29094322/usefulness-of-laparoscopy-and-intraductal-ultrasonography-in-a-patient-with-isolated-immunoglobulin-g4-related-sclerosing-cholangitis
#7
Yoshinori Ohno, Teru Kumagi, Yoshiki Imamura, Taira Kuroda, Mitsuhito Koizumi, Takao Watanabe, Osamu Yoshida, Yoshio Tokumoto, Eiji Takeshita, Masanori Abe, Kenichi Harada, Yoichi Hiasa
Immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) is often associated with type 1 autoimmune pancreatitis, and the frequency of isolated IgG4-SC seems to be quite low, making the diagnosis of isolated IgG4-SC challenging. A 63-year-old male was admitted to our hospital for frequent fever. Abdominal magnetic resonance cholangiopancreatography showed diffuse narrowing of the common bile duct and post-stenotic dilatation of the right posterior bile duct. Laboratory tests showed abnormalities in the levels of hepatobiliary enzymes and serum IgG4 levels...
November 1, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29090424/spontaneous-external-biliary-fistula-arising-from-an-intrahepatic-duct
#8
Naoto Mizumura, Satoshi Okumura, Hiroshi Tsuchihashi, Masao Ogawa, Masayasu Kawasaki
A spontaneous external biliary fistula is most commonly a cholecystocutaneous fistula secondary to acute cholecystitis. A fistula arising from an intrahepatic duct is extremely rare. An 87-year-old man presented with swelling of the epigastric region and right upper quadrant abdomen. He had a history of cholecystectomy and endoscopic sphincterotomy. After antibiotic treatment and surgical opening of both lesions, abdominal computed tomography demonstrated a soft tissue mass cephalad to the umbilicus. We excised the mass, and found it to be associated with a fistula through the linea alba...
October 31, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29086227/a-successful-case-of-locally-advanced-pancreatic-cancer-undergoing-curative-distal-pancreatectomy-with-en-bloc-celiac-axis-resection-after-combination-chemotherapy-of-nab-paclitaxel-with-gemcitabine
#9
Masahide Hiyoshi, Atsushi Nanashima, Takashi Wada, Yuki Tsuchimochi, Takeomi Hamada, Koichi Yano, Naoya Imamura, Yoshiro Fujii
Pancreatic cancer patients have a poor prognosis because of a low rate of resection that results from distant metastases or local advancement. We report a successful case of unresectable locally advanced pancreatic cancer in a patient who was curatively resected after combination therapy with nab-paclitaxel (nab-PTX) and gemcitabine (GEM). A 61-year-old man was referred for treatment of a 45-mm pancreatic tail tumor involving the celiac axis, common hepatic artery, and splenic artery that appeared as an abnormal soft-density mass on imaging...
October 31, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29082453/rapidly-growing-hepatocellular-carcinoma-after-direct-acting-antiviral-treatment-of-chronic-hepatitis-c
#10
Toshihiro Kawaguchi, Tatsuya Ide, Hironori Koga, Reiichiro Kondo, Ichiro Miyajima, Teruko Arinaga-Hino, Reiichiro Kuwahara, Keisuke Amano, Takashi Niizeki, Masahito Nakano, Ryoko Kuromatsu, Takuji Torimura
We report on a 62-year-old man with chronic hepatitis C who developed rapidly growing hepatocellular carcinoma (HCC) after achieving sustained virological response at post-treatment week 24 (SVR 24) by direct-acting antiviral (DAA) treatment. In 2008, he failed interferon therapy at 56 years of age. He received daclatasvir plus asunaprevir for 24 weeks after confirmation of no liver tumor by abdominal ultrasonography. He had no advanced liver fibrosis. Three months after initiation of DAA treatment, a liver tumor measuring 6 mm in diameter was detected by ultrasonography and confirmed with magnetic resonance imaging...
October 29, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29079895/early-esophageal-cancer-with-epidermization-diagnosed-and-treated-with-endoscopic-resection
#11
Satoshi Yamanouchi, Yukiko Sako, Shinsuke Suemitsu, Kousuke Tsukano, Satoshi Kotani, Ryusaku Kusunoki, Youichi Miyaoka, Tatsuya Miyake, Hirofumi Fujishiro, Naruaki Kohge, Tomohiko Yamamoto, Hideyuki Ohnuma
The patient was a 57-year-old man who had undergone endoscopic submucosal dissection for early esophageal cancer (distance from incisor tooth, 30 cm) when he was 50 years of age. Pathological findings showed squamous cell carcinoma invading the lamina muscularis mucosae and mild lymphatic invasion. Considering the possibility of lymph node metastasis and distant metastasis, we administered radiation chemotherapy (CDDP+ 5-FU, total radiation 41.4 Gy) in the same year. Two years later, follow-up endoscopy revealed a white, flat, elevated lesion in the thoracic esophagus (distance from incisor tooth, 36 cm) that was not stained by Lugol's iodine...
October 27, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29067636/a-novel-finding-of-rapunzel-syndrome
#12
Itaru Iwama, Ryusuke Nambu, Tomoko Hara
Rapunzel syndrome is a rare form of gastric trichobezoar (hair ball) involving extension of a tail of the hair into the small bowel. A 13-year-old girl was admitted with a 4-day history of epigastric pain and nausea which worsened after meals. Abdominal ultrasound showed duodenal wall thickening and lymphadenopathy. Esophagogastroduodenoscopy identified a gastric trichobezoar with a tail extending into the duodenum. In addition, multiple longitudinal duodenal and jejunal ulcers were noted. The ulcers appeared to be a result of direct pressure by the tail itself against the intestinal mucosa...
October 24, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29052124/endoscopic-biliary-stenting-for-unresectable-malignant-hilar-obstruction
#13
REVIEW
Mitsuharu Fukasawa, Shinichi Takano, Hiroko Shindo, Ei Takahashi, Tadashi Sato, Nobuyuki Enomoto
Palliative drainage is the primary treatment option for unresectable malignant hilar biliary obstruction (UMHBO) to improve the prognosis and quality of life. Currently, endoscopic biliary drainage is considered as a first-line treatment for UMHBO as well as for distal biliary obstruction. Self-expanding metal stents (SEMSs) are preferred over plastic stents (PSs) in patients with life expectancy of >3 months. However, endoscopic treatment of UMHBO is often more challenging and complex than that of distal biliary obstruction...
October 19, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29052123/successful-chemotherapy-with-modified-folfirinox-for-pancreatic-acinar-cell-carcinoma
#14
Minami Hashimoto, Takuto Hikichi, Tomohiro Suzuki, Mayumi Tai, Osamu Ichii, Nobuo Matsuhashi, Eisaku Kita, Shintaro Takahashi, Yoshinori Okubo, Hando Hakozaki, Yutaka Ejiri, Hiromasa Ohira
Abdominal ultrasonography revealed a pancreatic mass in a 67-year-old man with diabetes mellitus. Endoscopic ultrasound-guided fine needle aspiration led to the histological diagnosis of acinar cell carcinoma. The clinical stage was determined to be IVb based on findings of multiple metastatic lesions in the liver and lymph nodes, as well as splenic vein infiltration. Because the patient was not a surgical candidate, he underwent chemotherapy with modified FOLFIRINOX. In the absence of any severe adverse events, 12 courses of chemotherapy were delivered, resulting in marked shrinkage of both the primary and metastatic lesions...
October 19, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29039114/long-term-survival-after-repeated-resection-of-metachronous-lung-metastases-from-pstage-ia-pancreatic-adenocarcinoma
#15
Mamoru Miyasaka, Takehiro Noji, Kazuto Ohtaka, Ryohei Chiba, Shoki Sato, Yasuhito Shoji, Ryunosuke Hase, Tatsunosuke Ichimura, Satoshi Hirano, Naoto Senmaru
CASE REPORT: A 70-year-old woman with pancreatic ductal adenocarcinoma was initially treated by distal pancreatectomy (DP). Thirty-five months later, another tumor appeared in the pancreatic head and was treated by pancreaticoduodenectomy. Histopathological findings identified both tumors as pancreatic ductal adenocarcinoma pStage IA. Computed tomography (CT) of the chest 16 months after the second pancreatectomy revealed a ground-glass opacity in segment 3 of the right lung. Chest CT 23 months after the second pancreatectomy revealed a nodular shadow in segment 1a of the right lung...
October 16, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29039113/a-gastric-glomus-tumor-resected-using-non-exposed-endoscopic-wall-inversion-surgery
#16
Masahide Ebi, Tomoya Sugiyama, Kazuhiro Yamamoto, Takuya Saito, Tadahisa Inoue, Yoshiharu Yamaguchi, Yasuhiro Tamura, Shinya Izawa, Yasutaka Hijikata, Yasushi Funaki, Naotaka Ogasawara, Makoto Sasaki, Kunio Kasugai
Gastric glomus tumors are extremely rare, constituting approximately 1% of gastric mesenchymal tumors. We report the case of a 45-year-old female patient in whom upper gastrointestinal endoscopy revealed a 3-cm submucosal tumor with a bridging fold in the posterior wall of the antrum of the stomach. Contrast-enhanced computed tomography revealed the tumor to be hypervascular in the arterial phase and exhibit continuous enhancement in the post-venous phase. Dynamic contrast-enhanced magnetic resonance imaging showed that the tumor was hypervascular in the early phase and persistently enhanced in the late phase...
October 16, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29030789/foreign-bodies-in-sigmoid-colon-diverticulosis
#17
REVIEW
Ellen Ross, Patricia McKenna, John H Anderson
This review addresses the management of sigmoid colon diverticular disease associated with foreign bodies. In addition, two novel cases are presented. One case describes the management of diverticular bleeding secondary to a chicken bone and the other case reports retrieval of a retained EndoRings™ Device. The review identified 40 relevant publications including 50 subjects. Foreign bodies within sigmoid diverticular disease may be associated with inflammation, perforation, abscess and fistula. In current practice, diagnosis is often achieved with CT scan...
October 13, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/28988410/a-case-of-macrocystic-type-serous-cystic-neoplasm-with-repeated-pancreatitis-within-a-short-period-of-time
#18
Akihiko Kida, Yukihiro Shirota, Tsuyoshi Suda, Yuji Houdo, Katsuaki Sato, Tokio Wakabayashi
The patient was a 39-year-old woman in whom computed tomography (CT) in 201X had revealed a pancreatic cystic neoplasm (PCN) of 4.3 cm in diameter in the pancreatic body. In June 201X + 3, the patient consulted our hospital regarding severe acute pancreatitis. The condition improved through treatment with large-volume fluid replacement and continuous regional arterial infusion therapy. Thereafter, acute pancreatitis recurred twice, in November 201X + 3 and in January 201X + 4. During an 8-month period, acute pancreatitis occurred three times...
October 7, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/28988405/a-case-of-adenocarcinoma-developed-in-the-small-intestine-with-chronic-strongyloidiasis
#19
Satoshi Ishikawa, Tamaki Maeda, Kimiaki Hattori, Takahiro Watanabe, Takanori Kuramoto, Saori Ueno, Goro Ueno, Tadahiro Yamada, Akifumi Kanazawa, Masahiro Sakaguchi, Yoshitane Tsukamoto
We experienced a case of intestinal strongyloidiasis complicated by jejunal carcinoma. A Japanese male in his 50s, who has a 7-year medical history of duodenal ulcers, complained of loss of appetite, nausea, vomiting and diarrhea. Computed tomography and gastroduodenal endoscopic examination revealed a stenosis of the duodenum. To remove the stenosis, gastric bypass surgery was performed. The pathological diagnosis of the resected jejunum was strongyloidiasis and well-differentiated adenocarcinoma with subserosal invasion and vascular infiltration...
October 7, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/28986726/acute-pancreatitis-onset-carcinoma-in-situ-of-the-pancreas-with-focal-fat-replacement-diagnosed-using-serial-pancreatic-juice-aspiration-cytologic-examination-space
#20
Tatsunori Satoh, Masataka Kikuyama, Shinya Kawaguchi, Hideyuki Kanemoto, Hiroyuki Muro, Keiji Hanada
A 59-year-old woman was admitted for acute pancreatitis. Abdominal computed tomography and magnetic resonance imaging revealed a swollen pancreatic parenchyma with dilatation of the main pancreatic duct (MPD) of the pancreas tail, which was separated from the normal pancreas body side by a locally atrophic part of the pancreas. Magnetic resonance cholangiopancreatography showed MPD stricture in the pancreas tail with dilatation of the upstream MPD. Endoscopic ultrasonography revealed that the MPD stricture of the pancreas tail was surrounded by a blurred and hypoechoic area...
October 6, 2017: Clinical Journal of Gastroenterology
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