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Shin'ichi Takahashi

Publications and source records attributed to Shin'ichi Takahashi.

At least 19 recordsLinked to original sources
PubMed2006

Case-control study on the association of upper gastrointestinal bleeding and nonsteroidal anti-inflammatory drugs in Japan.

OBJECTIVE: Studies in Western populations have shown the association of nonsteroidal anti-inflammatory drugs (NSAIDs) and upper gastrointestinal bleeding (UGIB). The role of Helicobacter pylori infection in NSAIDs-related UGIB remains to be studied. We conducted a case-control study in Japan to investigate these related topics. METHODS: Cases of UGIB due to duodenal or gastric ulcer, or gastritis were identified in 14 study hospitals in various areas of Japan. For each case, two controls were identified from population registries in the same district. Information on drugs and other risk factors was obtained from 175 cases and 347 controls by telephone interviews. Anti-H. pylori antibody in the urine was measured in a single laboratory for all the cases and 225 controls. RESULTS: The odds ratio (OR) of UGIB was 5.5 for aspirin and 6.1 for other NSAIDs (NANSAIDs) (p<0.01). The OR for regular use was higher than for occasional use both for aspirin (7.7 vs 2.0) and NANSAIDs (7.3 vs 4.1). Loxoprofen (5.9), frequently used in Japan as a safe 'prodrug', was significantly associated with UGIB. The odds ratio for H. pylori infection was 4.9 and the relative excess risk due to the interaction between H. pylori and the use of NSAID was 1.2 (95% CI: -5.8-8.1). CONCLUSION: NSAIDs including loxoprofen increase the risk of UGIB in Japan as in Western countries, with a similar magnitude of association. There was no evidence of biological interaction between NSAIDs and H. pylori infection.

Adult↗
PubMed2006

Choledochocele demonstrated on conventional sonography.

Choledochocele is the least common form of choledochal cyst. We report a rare bile duct cyst diagnosed in a 63-year-old woman via CT cholangiography. Although conventional sonography initially failed to reveal abnormal findings, a subsequent detailed study clearly depicted the lesion. To the best of our knowledge, this is the first report of choledochocele unambiguously demonstrated on transabdominal sonography.

Cholangiography↗
PubMed2006

[Generalization of Helicobacter pylori eradication therapy and its future in Japan].

After official acceptance of eradication therapy for Helicobacter pylori infected peptic ulcer disease in 2000, this treatment has been generalized as ulcer therapy in Japan. In 2003 the consensus statement of the Japanese Society for Helicobacter Research (JSHR) for Helicobacter pylori infection was presented. According to this statement MALT lymphoma was recommended to treat H. pylori infection because of the efficacy of its out come. Atrophic gastritis was also advised to treat H. pylori infection for the purpose of preventing gastric cancer development. The extra alimentary disease such as idiopathic thrombocytopenic purpura was still under evaluation. In diagnostic method the importance of drug susceptibility test is rising because of the increase of drug resistant H. pylori strain in Japan. The false positive case of urea breath test, the accuracy of new Japanese original serology tests and the stool antigen test are also under investigation. The standard regimen of H. pylori eradication therapy in Japan is proton pomp inhibitor (PPI) + amoxicilin (AMPC) + clarithromycin (CAM). The problem of this regimen is the decrease of eradication rate. The reason of this trend might be increase of CAM resistant strain. JSHR recommended a rescue regimen as PPI + AMPC + metronidazole for the patient whose first eradication therapy was unsuccessful result. The eradication of this second line regimen was reported as about 90%.

Amoxicillin↗
PubMed2005

Effect of oral branched chain amino acid-rich nutrient administered during endoscopic injection sclerotherapy of cirrhotic patients.

Endoscopic injection sclerotherapy (EIS) is conducted to treat esophageal varices associated with liver cirrhosis. Cirrhotic patients have protein energy malnutrition (PEM), and their malnutrition is aggravated during EIS due to dietary restrictions. The aim of this study was to evaluate the dietetic benefits of oral branched chain amino acid-rich nutrient (BCAA-rich nutrient) administered during EIS. Cirrhotic patients admitted for prophylactic EIS were divided into three groups: Group A given a general liquid nutrient in two divided doses, Group B given a BCAA-rich nutrient in two divided doses, and Group C given the BCAA-rich nutrient in four divided doses. The nutritional state was evaluated based on physical examinations, biochemical parameters, and indirect calorimetry. A total of 29 patients were enrolled. Blood biochemical examinations showed a significant increase in the Fischer's ratio in Groups B and C. Group B showed significant decreases in resting energy expenditure/basal metabolic rate, while Group C showed a significant rise in non-protein respiratory quotient. The oxidation rate of carbohydrate significantly increased and that of fat significantly decreased in Group C. Administration of the BCAA-rich nutrient is considered to be useful in improving abnormalities of energy metabolism during EIS.

Journal Article↗
PubMed2005

Ménétrier's disease in a patient with Helicobacter pylori infection is linked to elevated glucagon-like peptide-2 activity.

This report focuses on a 59-year-old male Japanese patient with Ménétrier's disease who suffered from severe hypoproteinemia and tested positive for Helicobacter pylori when initially admitted to hospital. Blood levels of intact glucagon-like peptide-2 (GLP-2) were determined by specific bioassay, using serum-induced cAMP production in COS-7 cells expressing recombinant human GLP-2 receptors as a functional readout. Eradication of H. pylori led to remission of Ménétrier's disease as well as a partial yet significant decrease in GLP-2 levels, and also improved hypoproteinemia. These observations suggest a possible link between excess systemic endogenous production of GLP-2, a gut hormone that induces mucosal growth, and the hypertrophic gastropathy in a Ménétrier's disease patient with H. pylori infection.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2005

Amoxicillin resistance in Helicobacter pylori: studies from Tokyo, Japan from 1985 to 2003.

BACKGROUND: Previous reports revealed no resistant strains of amoxicillin (AMPC), which is usually used in eradication therapy for H. pylori infection. However, the frequency and evolution of natural AMPC-resistant strains in the Japanese population remains unknown. AIM: To assess the prevalence of H. pylori resistance against AMPC in the Tokyo area, a collection of 648 H. pylori strains isolated from patients with GI diseases from 1985 to 2003 was tested for their sensitivity to AMPC. METHODS: The susceptibility of the strains was assessed by determination of the minimal inhibitory concentration (MIC) using the E-test and/or the Dry-plate method. The susceptibility breakpoints of AMPC for H. pylori were: sensitive (AMPC-S); MIC < 0.04 microg/ml, intermittent resistance (AMPC-I); 0.04-1, resistant (AMPC-R); > 1. RESULTS: No AMPC-R strains were detected in the strains isolated between 1985 and 1996, while the rate of resistance was determined to be 1.1%, 2.1%, 5.4%, 5.6%, 0%, 8.8%, and 1.5% every year, respectively, from 1997 to 2003. The percentage of AMPC-I strains increased from 2000 to 2003. The total eradication rate of H. pylori in the patients who received triple therapy containing AMPC was 81.4% (214/263). Classified as above, the rates of AMPC-S, AMPC-I, and AMPC-R were 84.6%, 77.8%, 25%, respectively. CONCLUSION: H. pylori resistance to AMPC is still rare in Japan, although the percentage of AMPC-I strains has increased over the last 4 years. The frequency of isolation of strains showing true resistance to AMPC may increase in the future, along with an increase in the frequency of isolation of AMPC-I strains.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2005

[Evaluation of 13C-urea breath test to confirm eradication of Helicobacter pylori].

This study aimed to evaluate the effectiveness of the 13C-urea breath test (UBT) for assessment of Helicobacter pylori eradication after treatment. One hundred twenty six patients were enrolled with 85 receiving proton pomp inhibitor based triple therapy. They were underwent upper gastrointestinal endoscopy with biopsies for diagnosis and assessment of H. pylori infection using culture, histology, rapid urease test (RUT) and 13C-UBT. Assessment of eradication needs to be performed 4 weeks or more after completion of treatment. Breath samples were taken 15 minutes after the ingestion of 100 mg 13C-urea. Breath samples were analyzed on a mass spectrometer system. The gold standard for H. pylori infection was a positive culture or positive histology + positive RUT; negative for infection was defined as negative results of all three biopsy tests. Based on ROC curves, the most appropriate cut-off value for diagnosis of H. pylori infection was identified as 2.5/1000, which provided 96.2% sensitivity, 100% specificity, and 96.8% accuracy as judged by the gold standard. However, when confirming the eradication of H. pylori, it was 3.5/1000, which provides for 100%, 95.8%, and 96.5%, respectively. Ten patients (11.8%) had delta13C values that were 2.5-5.0/1000 4-12 weeks after therapy. Eight patients were considered cured of H. pylori infection, and 2 were considered to still have H. pylori infection following 13C-UBT, serology, and H. pylori specific antigen test. The false-positive rate of 13C-UBT was 9.4% (8/85). When the grey zone of 13C-UBT was set at a level of 2.5 to 5.0/1000 (2.5 > : negative, 5.0 < or = : positive) after eradication therapy, the sensitivity and specificity of 13C-UBT was 100% and 98.4% compared to the gold standard. It was concluded that to avoid false-positive results of 13C-UBT, the grey zone of 13C-UBT needs to be set at a level of 2.5 to 5.0/1000; thus improving the accuracy of test for the assessment of eradication of H. pylori infection.

Adult↗
PubMed2004

[Helicobacter pylori stool antigen test].

In Japan, Helicobacter pylori stool antigen(HpSA) test was opened for diagnosis of H. pylori infection before and after eradication therapy form Nov. 1, 2003. We can use two kinds of HpSA kits, Premier Platinum HpSA(Meridian Bioscience, USA) and Testmate pylori antigen EIA(Wakamoto Pharmaceutical Co., Ltd., Japan). We evaluated the diagnostic accuracy of the HpSA test(Premier Platinum HpSA) compared with diagnosis based on endoscopic biopsy-based methods. In 136 patients, the sensitivity and specificity of the HpSA test before therapy were 98.3% and 95.0%, respectively. In 54 patients, the sensitivity and specificity of the HpSA test after eradication therapy were 90% and 97.7%, respectively. Therefore, it is concluded that the HpSA test is a useful method for the diagnosis of H. pylori infection before and after eradication therapy.

Antigens, Bacterial↗
PubMed2003

Endoscopic hemostasis: safe treatment for peptic ulcer patients aged 80 years or older?

BACKGROUND AND AIM: Recently, the number of peptic ulcer patients aged 80 years or older has been increasing. However, little information is available concerning therapeutic endoscopy for these patients. The objective of this study was to evaluate the efficacy of endoscopic hemostasis for peptic ulcer bleeding in patients aged 80 years or older. METHODS: In this 7-year study, bleeding peptic ulcer patients were divided into group A (>/=80 years old) and group B (<80 years), for which prospective data, endoscopic findings and outcomes of endoscopic treatment were compared. RESULTS: Of the 459 patients who underwent endoscopic hemostasis for peptic ulcer bleeding, the 42 patients (average age 84 +/- 3 years) in group A had a significantly higher incidence of concomitant disease, lower hemoglobin, transfusional requirement over 800 mL and lower serum albumin than the 417 patients (average age 55 +/- 13 years) in group B. Significantly more patients in group A had large gastric ulcers. More patients in group A had ulcers located at the proximal third of the stomach, which is technically difficult to treat endoscopically. Nevertheless, all patients in groups A and B underwent initial hemostasis successfully. The rebleeding rate was not significantly different between group A and B. Neither group had hospital deaths nor complications related to endoscopic procedures. CONCLUSIONS: Endoscopic hemostasis for peptic ulcer bleeding in patients aged 80 years or older is effective and safe. Increasing age may no longer be a risk factor for rebleeding and hospital death after endoscopic hemostasis for peptic ulcer bleeding.

Aged↗
PubMed2003

Evaluation of Helicobacter pylori stool antigen test before and after eradication therapy.

BACKGROUND AND AIM: The Helicobacter pylori stool antigen (HpSA) test is useful for initial diagnosis of H. pylori infection, but there is disagreement regarding its diagnostic accuracy after eradication therapy. The aim of the present study was to evaluate the diagnostic accuracy of the HpSA test before and after eradication therapy. METHODS: One hundred and thirty-six patients underwent upper gastrointestinal endoscopy with biopsies for the diagnosis of H. pylori infection using culture, histology and the rapid urease test. Fifty-four H. pylori-positive patients were treated with 1-week triple therapy. Six to 10 weeks after the end of therapy, the patients underwent re-endoscopy and received the same biopsy-based methods. In addition, the 13C-urea breath test was performed. The HpSA test was performed before and 6-10 weeks after the end of therapy. In 23 patients, the HpSA test was also performed at the end of therapy. RESULTS: Before therapy, the sensitivity and specificity of the HpSA test was 98.3% (95% confidence interval (CI): 95.9-100%) and 95.0% (95% CI: 75.1-99.9%), respectively. At the end of therapy, the HpSA tests were all negative both for eradication and non-eradication patients. The sensitivity and specificity of the HpSA test after eradication therapy were 90% (95% CI: 55.5-99.7%) and 97.7% (95% CI: 93.3-100%), respectively. CONCLUSIONS: The HpSA test is a useful method for the diagnosis of H. pylori infection before and after eradication therapy.

Adult↗
PubMed2003

[The antimicrobial susceptibility test of Helicobacter pylori].

Now that treatment of H. pylori associated disease is becoming common in Japan, drug resistant--H. pylori has emerged as a problem to be solved. There is no standard method of H. pylori drug susceptibility test in Japan yet. There are several methods available: Disk test, E-test, microplate method and agar plate dilution method. The E-test is being the standard method in European countries and USA. However the microplate method has been reported as a same accuracy as the agar dilution method, and thought as being a new standard method in Japan. In 2000, The Japanese Society of Chemotherapy proposed that drug susceptibility test be standardized and listed the break point of MIC of amoxicillin(AMPC) and clarithromycin(CAM).

Drug Resistance, Bacterial↗
PubMed2002

Long-term Helicobacter pylori infection and the development of atrophic gastritis and gastric cancer in Japan.

The incidence of gastric cancer and the prevalence of Helicobacter pylori are high in Japan, so it is an important issue whether long-term H. pylori infection leads to chronic atrophic gastritis, considered one of the precursors of gastric cancer. We have reported that the grade of atrophy was higher in H. pylori-positive subjects than in H. pylori-negative subjects. It has also been reported that the atrophy of gastric mucosa increased in H. pylori-infected monkeys compared with control monkeys in a 5-year follow-up study. Most H. pylori infections occur in children, and atrophy of the gastric mucosa progresses during aging. Long-term data show that H. pylori infection can lead to gastric atrophy and may play an important role in the development of gastric cancer. Interestingly, there was no difference in the prevalence of H. pylori between patients with chronic gastritis and gastric cancer in Japan, but the prevalence of H. pylori in young Japanese gastric cancer patients was significantly higher than in the control group. These data clearly show that H. pylori infection is one of the risk factors of gastric cancer in young Japanese people, There is no answer to whether curing H. pylori infection can reverse the atrophy of the gastric mucosa and decrease the risk of gastric cancer development. To clarify this issue, an intervention study must be done. A large clinical trial called the Japanese Intervention Trial of H. pylori is in progress.

Adult↗