Japanese Society Of Gastroenterology Research Articles

Analysis on Awareness of Functional Dyspepsia and Rome Criteria Among Japanese Internists by the Self-administered Questionnaires

Background/AimsFunctional dyspepsia (FD) is one of the commonest diseases in the field of Internal Medicine. The Japanese Society of Gastroenterology (JSGE) has been enlightening the term and concept of FD. Aim of this survey was to elucidate the understanding status of FD and Rome criteria and attitude toward FD among Japanese internists.MethodsData were collected at the time of lifelong education course for certified members of Japanese Society of Internal Medicine. Self-administered questionnaires were delivered to the medical doctors prior to the lectures.ResultsAnalysis subjects were 1,623 (24-90 years old) internists among 1,660 medical doctors out of 4,264 attendees. The terms related to FD were known in 62.0-68.9% of internists, whereas 95.5% understood chronic gastritis. Internists who had been taking care of FD patients informed them as chronic gastritis (50.0%), FD in Japanese Kanji character (50.8%) and FD in Kanji and Katakana (18.6%). Logistic linear regression analysis revealed that positive factors for the understanding of FD and intensive care for FD patients were practitioner, caring many patients and certified physician by JSGE. Existence of Rome criteria was known in 39.9% of internists, and 31.8% out of them put it to practical use. The certified physician by JSGE was a positive factor for awareness, but not for utilization.ConclusionsThe results suggest the needs of enlightening the medical term FD in Japan and revision of Rome criteria for routine clinical practice. Precise recognition of FD may enhance efficient patient-based clinical practice.

Early gastric cancer: diagnosis, staging, and clinical impact. Evaluation of 530 patients. New elements for an updated definition and classification

The prevention and early diagnosis of gastric cancer permit clinicians to discover the tumor in the initial phase, during which time it can be completely eradicated, endoscopically or surgically. Since Murakami gave the definition of early gastric cancer (EGC) in 1971, many authors have identified various subtypes of EGC with different morphological characteristics and clinical behaviour. We evaluated retrospectively 530 patients: the median follow-up time was 10.4 months (range 0.3-29.2). All tumors were classified according to the macroscopic and microscopic criteria proposed by the Japanese Society of Gastroenterology and Endoscopy and Lauren, respectively. The infiltrative growth pattern was evaluated according to Kodama's classification. Only tumor-related death was considered as an endpoint of interest for the survival analysis. The overall survival rates of our patients were 94 % (95 % CI, 92-96) and 90 % (95 % CI, 87-93) at 5 and 10 years, respectively. Only 44 patients (8.3 %) died of the disease. Kodama's type (p < 0.0001), lymph node status, both for number and pathological stage according to the 7th Edition of TNM (p < 0.0001), and depth of infiltration (p = 0.0006) were significant prognostic factors in univariate analysis. The multivariate analysis identified Kodama's PENA type (HR, 3.91; 95 % CI, 2.08-7.33; p < 0.0001) and lymph node status for more than three positive nodes versus negative nodes (HR, 12.78; 95 % CI, 5.37-30.43; p < 0.0001) as the only independent prognostic factors in our series. Lymph node status, especially when more than three lymph nodes are involved, is the most important prognostic factor in EGC. However, it is also important to evaluate the infiltrative growth pattern of the cancers in their early phase according to Kodama's classification, considering PEN A type lesions to be more aggressive than the other EGC types. Then, we propose new elements for an updated definition and classification of EGC, with an important clinical impact on the treatment of patients.

Career advancement of women in the Japanese Society of Gastroenterology (JSGE)

Career advancement of women in the Japanese Society of Gastroenterology (JSGE)

Laryngopharyngeal symptoms due to the gastroesophageal reflux disease (GERD) and the GERD management guideline published by the Japanese Society of Gastroenterology

Laryngopharyngeal symptoms due to the gastroesophageal reflux disease (GERD) and the GERD management guideline published by the Japanese Society of Gastroenterology

わが国における肝細胞癌合併アルコール性肝硬変患者の特徴

We addressed the recent trend in alcoholic liver cirrhosis (LC) in Japan. Nation-wide survey was carried by asking the hospitals that are qualified by the Japanese Society of Gastroenterology for the number of hospitalized-patients of LC in 2007 and etiology of LC. Concerning hepatocellular carcinoma (HCC) in alcoholic LC, we also obtained age, sex, the amount of daily alcohol intake, period of habitual drinking, body mass index (BMI), prevalence of diabetes mellitus (DM) and obesity (BMI ≥25). Prevalence of HCC was 32.3% in male, and 19.8% in female. It was 39.7% in patients with DM (23.6% without DM) , 44.6% with obesity (23.9% without obesity), 48.8% over 65 y/o (20.0% younger than 65 y/o). Age, sex obesity and DM appeared to be involved in the progression of HCC in alcoholic LC. Improvement of total life style is important.

Equivalent Clinical Outcomes of Bleeding Peptic Ulcers in Teaching and Non-Teaching Hospitals: Evidence for Standardization of Medical Care in Japan

The clinical outcomes of treatments for several medical conditions are better in teaching hospitals than in non-teaching hospitals. However, there is only limited information for comparisons of the clinical outcomes of bleeding peptic ulcers between teaching and non-teaching hospitals. A total of 4,863 patients treated by endoscopic hemostasis on admission for bleeding peptic ulcers were evaluated in 586 hospitals of the Diagnosis Procedure Combination (DPC) system. We collected their data from the database associated with the DPC system to compare the risk-adjusted length of stay (LOS) and in-hospital mortality within 30 days with respect to the hospital characteristics. The hospitals were categorized into two groups: teaching hospitals that were certified by the Japanese Society of Gastroenterology (3,332 patients in 360 hospitals) and non-teaching hospitals (1,531 patients in 226 hospitals). There was no significant difference with regard to the mean LOS and the crude in-hospital mortality within 30 days between groups (p = 0.181 and 0.174, respectively). Multiple linear regression analyses revealed that the hospital characteristics were not associated with the risk-adjusted LOS. The standardized coefficient for non-teaching hospitals was 0.019 (p = 0.172). Multiple logistic regression analyses further showed no significant difference in the in-hospital mortality within 30 days (non-teaching hospitals, odds ratio = 1.35, 95% confidence interval = 0.786 - 2.319, p = 0.277). In conclusion, both teaching and non-teaching hospitals have equivalent qualities in management of bleeding peptic ulcers. These findings suggest that the standardization of medical treatments for bleeding peptic ulcers has become disseminated in Japan.

The revised Japanese clinical diagnostic criteria for chronic pancreatitis

In Japan, we are now using the clinical diagnostic criteria for chronic pancreatitis (CP) that were revised in 2001 to add the findings of magnetic resonance cholangiopancreatography to the criteria compiled by the Japan Pancreas Society (JPS) in 1995. Because the current criteria are set for diagnosing advanced CP, they are unlikely to improve patients' prognoses. In addition, they seem unsuitable for current clinical practice because exocrine pancreatic function tests, which have become obsolete in Japan, are included in the diagnostic factors. For these reasons, the Research Committee on Intractable Pancreatic Diseases supported by the Ministry of Health, Labour and Welfare of Japan, the JPS and the Japanese Society of Gastroenterology have revised the criteria. The revised criteria are unique in that they contain an introduction to the concept of early CP. It is a challenge aimed at improvement of the long-term prognosis of CP patients by early diagnosis and therapeutic intervention in this disease. We need to determine and clarify the clinico-pathological outcome of early CP by a prospective long-term follow-up of the patients in this category.

Preface

Atomi Y Arii S On behalf of the Japanese Society of Gastroenterology (JSGE) and Japan Society of Hepatology (JSH), we are delighted to have sponsored the Second International Symposium on Alcoholic Liver and Pancreatic Diseases (ALPD) and Cirrhosis, as part of JDDW2007 in Kobe, Japan. This symposium followed an overwhelming success of the first symposium held in Marina del Rey, California in 2006 and was made possible through joint sponsorships of JSGE, JSH, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a component of the National Institutes of Health within the US Department of Health and Human Services, and the Southern California Research Center for ALPD and Cirrhosis. The symposium marked the first major collaboration between these cosponsors, setting an important precedent as we have taken steps towards our global initiative to elucidate the molecular mechanisms that underlie ALPD and cirrhosis. In many nations, ALPD are the two most common alcohol-associated lifestyle diseases. As the liver and pancreas share developmental, anatomical, biological, and pathological commonalities, it makes sense to unite leading experts in these two areas to engage in discussions on the scientific disciplines common to both. In fact, this year's symposium united more than 150 participants from 17 nations, with 41 invited speakers/moderators and 40 poster presenters who discussed the most current and cutting-edge research on ALPD and cirrhosis. The primary presentation themes included cell death and survival; oxidant stress and inflammation; clinical research on ALPD; metabolism, cancer, and genetics; stellate cell biology and fibrosis; and global networking. A gathering of such a uniquely diverse body of distinguished presenters and attendees was unparalleled, and the resulting discussions were most enlightening. We would like to acknowledge the presence and invaluable contributions of two particularly distinguished guests, Dr Ting-Kai Li, Director of the NIAAA, who delivered an opening lecture for the symposium; and Dr Bertrand Nalpas from INSERM, the sole French public organization dedicated to biological, medical, and public health research, who made special remarks on the alcohol-research program of INSERM for the global networking session. It is satisfying to know that the excitement of this symposium will be passed onto the third symposium now scheduled to take place under the leadership of Dr Jose Mato in Bilbao, Spain in July 2008. Furthermore, proposals to host the fourth and fifth symposia in Egypt and France in 2009 and 2010, respectively, have already been made during the meeting in Kobe. We would like to take this opportunity to thank all the sponsors for their financial and logistic support, and the organizing committee for its excellent planning and coordination, without which this symposium would not have been possible. We also wish to extend our gratitude to all attendees, many of whom traveled a great distance to take part in this landmark scientific event.

Severe Alcoholic Hepatitis in Japan: Prognosis and Therapy

Recently, the incidence of alcoholic liver disease (ALD) has been increasing in Japan; this associated with an increase in alcoholic beverage consumption. Multiple organ failures are frequently observed in patients with severe alcoholic hepatitis (AH), most of whom have a poor prognosis similar to fulminant hepatitis; as well numbers of severe AH patients appear to be increasing. Although prognosis of fulminant hepatitis in Japan has been recently improved by intensive treatments such as plasma exchange (PE) that of severe AH has not changed. The objective of this study was to determine whether there was any factor that could determine the prognosis of severe AH. We carried out nation-wide survey by asking hospitals certified by the Japanese Society of Gastroenterology and hospitals related to ours hospital for the current status of patients seen with severe alcoholic hepatitis since 1998. We investigated correlations between various factors including blood laboratory data, presence of other organ failure, and prognosis. Mortality of patients with severe AH was high (66.4%). The ratio of female patients with severe AH (26%) was higher than that for other ALD (approximately 10%). Mean age was older (Alive: 44 +/- 11; Dead: 50 +/- 11 years old), white blood cell (WBC) counts were higher (11600 +/- 5200; 21800 +/- 13400/microl), red blood cell counts were lower (320 +/- 95; 265 +/- 72 x 10/microl) and prothrombin time (PT) was prolonged (36.2 +/- 10.4; 29.1 +/- 9.4%, respectively) in patients who had died than in patients who had survived. However, as all differences diminished after carrying out PE, we analyzed data in patients without PE. The results were similar to those in all patients. Prevalence of infection, gastrointestinal (GI) bleeding and disseminated intravascular coagulation (DIC) was higher in patients who had died. Although intensive treatments such as PE, hemodialysis, and anticoagulation therapy did not change the prognosis of severe AH, PE improved the prognosis of patients without either GI bleeding or DIC. WBC counts were also slightly higher in patients who had died after carrying out PE. Two cases had been cured by granulocytapheresis (GCAP) CONCLUSIONS: PE can compensate for and reduce the risk due to prolonged PT in patients with severe AH. These results suggest that the patients with markedly elevated WBC counts, prolonged PT, or anemia should, if possible, be treated at an earlier stage with an intensive treatment such as PE, hemodialysis, or anticoagulation therapy before infection, GI bleeding or DIC occurs. Further, GCAP might be useful for severe AH patients with higher WBC counts.

わが国における大酒家慢性肝炎の現状

The objectives of this study were to determine whether hepatitis virus affects chronic alcoholic hepatitis. A nationwide survey of hospitals qualified by the Japanese Society of Gastroenterology was conducted to determine the status of alcoholic liver disease (ALD) in-patients since 1998. The prevalence of hepatitis virus infection in each kind of ALD patient was also investigated. Regarding chronic alcoholic hepatitis, we confirmed it was diagnosed by liver biopsy or not. Only 45 in 204 patients were diagnosed by liver biopsy as chronic alcoholic hepatitis. The percentage of chronic alcohol hepatitis patients without viral hepatitis was 24.5%. Hepatitis virus continues to play a crucial role in the pathogenesis of chronic alcohol hepatitis. Patients without liver biopsy were diagnosed by high ALT level in patients with ALD who were not enough for criteria of alcoholic hepatitis. New criteria are required for such patients.

The International Symposium of the 90th Annual Meeting of the Japanese Society of Gastroenterology in Sendai

The International Symposium of the 90th Annual Meeting of the Japanese Society of Gastroenterology in Sendai

SEVERE ALCOHOLIC HEPATITIS IN JAPAN.

Multiple organ failures are frequently observed in patients with severe alcoholic hepatitis. Most of the patients have a poor prognosis similar to fluminant hepatitis. Since alcohol intake has been recently increasing in Japan, severe alcoholic hepatitis is expected to be increased. The objective of this study was to determine whether there was any factor by which prognosis of severe alcoholic hepatitis was determined. We carried out nationwide survey by asking the hospitals that are approved by the Japanese Society of Gastroenterology for current incidence of alcoholic liver disease including severe alcoholic hepatitis. We investigated correlations between various factors including blood laboratory data, presence of other organ failure, and prognosis. White blood cell counts and serum creatinine levels were higher, red blood cell counts were lower and prothrombin time were prolonged in the patients who had died than in the patients who had survived. Prevalence of infection, gastrointestinal bleeding, and disseminated intravascular coagulation was higher in the patients who had died. These results suggest that the patients with markedly elevated white blood cell counts, prolonged prothrombin time, anemia, renal failure, infection, or gastrointestinal bleeding should be treated at an earlier stage with plasma exchange, hemodialysis, and anti-coagulation therapy. Since treatment with corticosteroid hormone may worsen the prognosis of severe alcoholic hepatitis, especially with infection or gastrointestinal bleeding, co-administration of anti-bacterial agents and protective drugs for gastrointestinal tracts should be considered.

National survey of hepatocellular carcinoma in heavy drinkers in Japan.

The major cause of hepatocellular carcinoma (HCC) in the general Japanese population is an infection related to hepatotropic viruses, especially hepatitis virus C (HCV). Even in heavy drinkers, the major cause of HCC is HCV infection. However, HCC without viral infection has been reported in heavy drinkers. Alcohol has been also reported to be associated with an increased risk of cancer. In this study, we investigated aspects of HCC pathogenesis in heavy drinkers in Japan. Questionnaires were sent to 1,350 hospitals authorized by the Japanese Society of Gastroenterology. The questionnaires asked about the number of inpatients with the different types of alcoholic liver diseases, admitted to each hospital between 1998 and 2001. The percentage of heavy drinkers among all admitted patients with liver diseases or liver cirrhosis was approximately 15%. Of the patients with alcoholic liver cirrhosis, the cirrhosis was derived from alcohol alone in 61% and from alcohol plus a virus in 39% of patients. Furthermore, the percentage of patients with alcoholic liver cirrhosis caused by alcohol alone and who did not have HCC was 80%. However, the percentage of HCC patients who tested negative for viral hepatitis serum markers was 27% of the total number of heavy drinkers admitted for HCC. A study mainly on liver cirrhosis performed in the early 1990's demonstrated that the alcohol-alone group accounted for 44% of admitted patients with alcoholic liver cirrhosis and 18% of heavy drinkers admitted for HCC. Because the consumption of alcohol is increasing in Japan, the frequency and number of cases of alcoholic liver cirrhosis are increasing. Viral hepatitis infection, however, still plays an important role in hepatocarcinogenesis in heavy drinkers. Radiographical examination is recommended even in patients with alcoholic liver cirrhosis who test negative for serum markers of viral hepatitis.

Snapshot of GI medicine in Japan

There are more than 10 major gastroenterology and hepatology societies in Japan, all of which are independent foundations, supported solely by membership dues. Each society convenes annual meetings, and the past decade has witnessed explosive growth in the number of gastroenterologists. There are 5 GI societies, including 3 major groups: The Japanese Society of Gastroenterology (http://www.jsge.or.jp/index.html), Japan Gastroenterological Endoscopy Society (http://www.jges.net/), and The Japan Society of Hepatology (http://www.jsh.or.jp/). In terms of research funding, most support in Japan comes from pharmaceutical companies, as government support is quite limited in comparison with the United States. Some basic scientists do receive extensive funding from government agencies, such as the Ministry of Health, Labor, and Welfare; the Ministry of Science and Education; or from several foundations with government ties. Still, GI faculties involved in clinical and basic GI research can obtain smaller grants from government agencies and foundations. Topics of regenerative medicine are being watched with keen interest in medical science. Last year, the Japanese Society of Regenerative Medicine (http://wwwsoc.nii.ac.jp/jsrm/Japanese/index.html) was established. The main gastroenterology area of interest is liver-targeted regenerative medicine using hepatocyte growth factor or embryonic stem cells for transplant bridge, differentiation of pancreatic beta cells from stem cells, or the differentiation of intestinal stem cells into beta cells by pdx1 overexpression. However, since it has been demonstrated that bone marrow cells can repopulate the epithelia of the human gastrointestinal tract (Watanabe et al., Nature Medicine 2002;8:1011-1017), a potential of bone marrow-derived stem cells for repairing severely damaged epithelia in the gastrointestinal tract will also provide new insights into the clinical applications of regenerative medicine.

Classification and nomenclature of gallstones revisited.

Over the decades, there has been a great deal progress in the understanding of gallstones owing to the continuous efforts aimed at elucidating their pathogenesis. An optimal classification system is needed because the etiology, pathogenesis, clinical features and treatment can be different according to the classes. Currently, two systems are widely used: one from the National Institutes of Health (NIH)-International Workshop on Pigment Gallstone Disease held in 1981 and the other from Gallstone Research Committee from the Japanese Society of Gastroenterology in 1984. However, some stones cannot be classified into either of these categories. In addition, several terms have been not been clearly defined. In several aspects, both systems need to be reevaluated. This paper reviewed the classification systems and terms that are currently used for gallstones, and raises several points that need to be reconsidered. In the near future, large scaled prospective studies on gallstones need to be carried out on the basis of the external color, chemistry, cutting surface, etc. Only when these studies are completed can an ideal classification system for gallstones be expected.

How to apply modern scientific and technological advances to the practice of clinical gastroenterology in Vietnam.

There are some differences between the spectrum of gastroenterological diseases in Vietnam compared with those of more developed countries. These may be due to different living standards, quality of nutrition, and different infection rates of intestinal parasites and hepatotropic viruses. Gastric carcinoma and hepatocellular carcinoma (HCC) are leading malignancies, while colorectal cancer is less frequent. Bile duct stones often have Ascaris eggs in the centre, and they prevail in incidence over gall-bladder stones. The majority of digestive cancers are detected at a very late stage. The Vietnamese Association of Gastroenterology aims to contribute to the development of modern gastroenterology (GE) in Vietnam, to study and apply recent advances in imaging technology, such as fibre-optic diagnostic and therapeutical endoscopy, ultrasonography, laparoscopic surgery etc. and to do further work in molecular biology. For this purpose, besides our self-reliance, we need, and ask for, support and assistance from the Japanese Society of GE (JSGE), the Asian Pacific Association of GE (APAGE) and the Organisation Mondiale de GE (OMEGE). At the same time, we suggest a choice be made among the different technologies, bearing in mind their cost-effectiveness, and to give preference to measures for the primary prevention and early detection of the diseases. Japanese experience in the early detection of gastric cancer and HCC, and in the Percutaneous Ethanol Injection Therapy (PEIT) for treatment of HCC, are highly appreciated. We recommend also a judicious and scientific combination of traditional medicine and modern technology in the research and the struggle against digestive diseases.

Past, present and future of gastroenterology in Japan: the 100th anniversary of the Japanese Society of Gastroenterology in 1998.

The Japanese Society of Gastroenterology (JSGE) will celebrate the centenary of its foundation in 1998. A variety of plans and projects are being prepared by the JSGE centennial celebration committee. In this article, the history of the JSGE is briefly described, and several projects, including the international symposium currently being planned, are introduced. The future prospects of our Society will also be described.

Abstracts of selected papers presented at the 34th annual meeting of the japanese society of gastroenterology

Abstracts of selected papers presented at the 34th annual meeting of the japanese society of gastroenterology

Abstracts of selected papers presented at the 78th general meeting of the Japanese Society of Gastroenterology

Abstracts of selected papers presented at the 78th general meeting of the Japanese Society of Gastroenterology

Digestive disease week of Japan 1994 and eightieth annual spring meeting of the Japanese Society of Gastroenterology

Digestive disease week of Japan 1994 and eightieth annual spring meeting of the Japanese Society of Gastroenterology