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( Saya Tsuda ),( Reiko Kunisaki ),( Jun Kato ),( Mayu Murakami ),( Masafumi Nishio ),( Tsuyoshi Ogashiwa ),( Takeichi Yoshida ),( Hideaki Kimura ),( Masayuki Kitano ) 대한장연구학회 2018 Intestinal Research Vol.16 No.4
Background/Aims: In clinical practice, colonoscopy has been regarded as the gold standard for the evaluation of disease severity as well as mucosal healing in ulcerative colitis (UC). Some activity indices incorporating patient symptoms as parameters have been shown to reflect the endoscopic activity of UC. The aim of this study was to examine whether self-reported symptoms with visual analog scales (VAS) can predict endoscopic activity. Methods: A cross-sectional study of 150 UC patients who underwent colonoscopy with submission of VAS scores of 4 symptoms: general condition, bloody stools, stool form, and abdominal pain (0: no symptoms, 10: the most severe symptoms). Each VAS score was compared with colonoscopic activity assessed with the Mayo endoscopic subscore (MES). Results: All VAS scores were significantly correlated with the endoscopic severity (Spearman correlation coefficients of general condition, bloody stools, stool form, and abdominal pain: 0.63, 0.64, 0.58, and 0.43, respectively). Mucosal healing defined as MES 0 alone was predicted by VAS score <1.5 on general condition or 0 on bloody stools with sensitivity of 0.84 and 0.76 and specificity of 0.66 and 0.76, respectively. Additionally, VAS score <2.5 on stool form predicted active lesions in distal colorectum alone with sensitivity of 0.67 and specificity of 0.66, suggesting that this item could predict the indication of topical therapy. Conclusions: Self-reported VAS scores on symptoms were correlated with endoscopic activity of UC. To clarify the relationship between VAS and mucosal healing, further validation studies are needed. (Intest Res 2018;16:579-587)
( Katsuhiro Arai ),( Reiko Kunisaki ),( Fumihiko Kakuta ),( Shin-ichiro Hagiwara ),( Takatsugu Murakoshi ),( Tadahiro Yanagi ),( Toshiaki Shimizu ),( Sawako Kato ),( Takashi Ishige ),( Tomoki Aomatsu 대한장연구학회 2020 Intestinal Research Vol.18 No.4
Background/Aims: There are few published registry studies from Asia on pediatric inflammatory bowel disease (IBD). Registry network data enable comparisons among ethnic groups. This study examined the characteristics of IBD in Japanese children and compared them with those in European children. Methods: This was a cross-sectional multicenter registry study of newly diagnosed Japanese pediatric IBD patients. The Paris classification was used to categorize IBD features, and results were compared with published EUROKIDS data. Results: A total of 265 pediatric IBD patients were initially registered, with 22 later excluded for having incomplete demographic data. For the analysis, 91 Crohn’s disease (CD), 146 ulcerative colitis (UC), and 6 IBD-unclassified cases were eligible. For age at diagnosis, 20.9% of CD, 21.9% of UC, and 83.3% of IBD-unclassified cases were diagnosed before age 10 years. For CD location, 18.7%, 13.2%, 64.8%, 47.3%, and 20.9% were classified as involving L1 (ileocecum), L2 (colon), L3 (ileocolon), L4a (esophagus/stomach/duodenum), and L4b (jejunum/proximal ileum), respectively. For UC extent, 76% were classified as E4 (pancolitis). For CD behavior, B1 (non-stricturing/non-penetrating), B2 (stricturing), B3 (penetrating), and B2B3 were seen in 83.5%, 11.0%, 3.3%, and 2.2%, respectively. A comparison between Japanese and European children showed less L2 involvement (13.2% vs. 27.3%, P<0.01) but more L4a (47.3% vs. 29.6%, P<0.01) and L3 (64.8% vs. 52.7%, P<0.05) involvement in Japanese CD children. Pediatric perianal CD was more prevalent in Japanese children (34.1% vs. 9.7%, P<0.01). Conclusions: Upper gastrointestinal and perianal CD lesions are more common in Japanese children than in European children. (Intest Res 2020;18:412-420)
Tacrolimus for ulcerative colitis in children: a multicenter survey in Japan
( Tadahiro Yanagi ),( Kosuke Ushijima ),( Hidenobu Koga ),( Takeshi Tomomasa ),( Hitoshi Tajiri ),( Reiko Kunisaki ),( Takashi Isihige ),( Hiroyuki Yamada ),( Katsuhiro Arai ),( Atsushi Yoden ),( Tomo 대한장연구학회 2019 Intestinal Research Vol.17 No.4
Background/Aims: Tacrolimus is effective for refractory ulcerative colitis in adults, while data for children is sparse. We aimed to evaluate the effectiveness and safety of tacrolimus for induction and maintenance therapy in Japanese children with ulcerative colitis. Methods: We retrospectively reviewed the multicenter survey data of 67 patients with ulcerative colitis aged <17 years treated with tacrolimus between 2000 and 2012. Patients’ characteristics, disease activity, Pediatric Ulcerative Colitis Activity Index (PUCAI) score, initial oral tacrolimus dose, short-term (2-week) and long-term (1-year) outcomes, steroid-sparing effects, and adverse events were evaluated. Clinical remission was defined as a PUCAI score <10; treatment response was defined as a PUCAI score reduction of ≥20 points compared with baseline. Results: Patients included 35 boys and 32 girls (median [interquartile range] at admission: 13 [11-15] years). Thirty-nine patients were steroid-dependent and 26 were steroid-refractory; 20 had severe colitis and 43 had moderate colitis. The initial tacrolimus dose was 0.09 mg/kg/day (range, 0.05-0.12 mg/kg/day). The short-term clinical remission rate was 47.8%, and the clinical response rate was 37.3%. The mean prednisolone dose was reduced from 19.2 mg/day at tacrolimus initiation to 5.7 mg/day at week 8 (P<0.001). The adverse event rate was 53.7%; 6 patients required discontinuation of tacrolimus therapy. Conclusions: Tacrolimus was a safe and effective second-line induction therapy for steroid-dependent and steroid-refractory ulcerative colitis in Japanese children. (Intest Res 2019;17:476-485)
( Shunsuke Komoto ),( Satoshi Motoya ),( Yuji Nishiwaki ),( Toshiyuki Matsui ),( Reiko Kunisaki ),( Katsuyoshi Matsuoka ),( Naoki Yoshimura ),( Takashi Kagaya ),( Makoto Naganuma ),( Nobuyuki Hida ),( 대한장연구학회 2016 Intestinal Research Vol.14 No.2
Background/Aims: Anti-tumor necrosis factor drugs (anti-TNF) and thiopurines are important treatment options in patients with inflammatory bowel disease (IBD), including during pregnancy. However, there are limited data on the benefit/risk profile of anti-TNF and thiopurines during pregnancy in Asia. The aim of this study was to analyze pregnancy outcomes of female Japanese IBD patients treated with anti-TNF and/or thiopurines. Methods: This cross-sectional study assessed pregnancy outcomes in 72 women with IBD. Pregnancy outcomes were compared among 31 pregnancies without exposure to infliximab (IFX), adalimumab (ADA), or thiopurines; 24 pregnancies with exposure to anti-TNF treatment (23 IFX, 1 ADA); 7 pregnancies with exposure to thiopurines alone; and 10 pregnancies with exposure to both IFX and thiopurines. Results: Thirty-five of the 41 pregnancies (85.3%) that were exposed to anti-TNF treatment and/or thiopurines resulted in live births after a median gestational period of 38 weeks. Of the 35 live births, 3 involved premature deliveries; 7, low birth weight; and 1, a congenital abnormality. There were 6 spontaneous abortions in pregnancies that were exposed to anti-TNF treatment (17.7%). Pregnancy outcomes among the 4 groups were similar, except for the rate of spontaneous abortions (P =0.037). Conclusions: Exposure to anti-TNF treatment or thiopurines during pregnancy was not related to a higher incidence of adverse pregnancy outcomes in Japanese IBD patients except for spontaneous abortion. (Intest Res 2016;14:139-145)