Chronic Pancreatitis: How to Make Irreversible Disease Reversible?

Tooru Shimosegawa 대한췌담도학회 2009 대한췌담도학회지 Vol.14 No.1

Disorders of Small and Large Intestine : Two Cases Of Cronkhite-Canada Syndrome With Gastrointestinal Cancer And Membranous Glomerulonephritis

( Eiki Nomura ),( Yoshitaka Kinouchi ),( Tooru Shimosegawa ),( Sho Takagi ),( Hisashi Shiga ),( Nobuya Obana ),( Katsuya Endo ),( Nobuo Ueki ),( Kenichi Negoro ),( Seichi Takahashi ) 대한소화기학회 2007 SIDDS Vol.9 No.-

Background/Aims: Cronkhite-Canada syndrome (CCS) is a rare nonhereditary disorder with gastrointestinal (GI) polyposis, associated with ectodermal changes. GI polyps are generally accepted to be nonneoplastic in nature. However, GI malignancy have been described in some CCS patients. Methods: Two cases of CCS associated with GI cancer and membranous glomerulonephritis (MGN) were examined about clinicopathological features. Results: 〔Case 1〕 A 71-year-old man had GI polyposis. The skin of his legs showed brown pigmentation and his fingernails and toenails were atrophic. He had proteinuria and the biopsied specimen of the kidney revealed MGN. We made a diagnosis of CCS associated with MGN. Treatment with methylprednisolone and cyclosporine ameliorated the symptoms and the GI polyposis Colonoscopy after the treatment showed the regression of the polyposis and the histological examination of the remnant polyp after endoscopic resection showed well differentiated adenocarcinoma. Twelve months after the resection, he achieved remission and no recurrence of the polyposis was found. 〔Case 2〕 A 58-year-old man was admitted our hospital for the examination of the progression of anemia. HE was diagnosed as MGN at 24 years old and was under medical treatment. He had poor nutrition, with the typical clinical features of CCS. He had also taste disturbance. Radiologic, endoseopic and histological examinations confirmed CCS polyposis in the stomach, small intestine and colon. He was treated with prednisolone, oral zinc and tranexamic acid and was improved of the symptoms. Six months after the diagnosis, follow-up upper GI scopy showed no change of the diffuse polyposis of the stomach, whereas the histological findings of the biopsied specimens from the lower body polyp revealed to be an adenocarcinoma. He was performed a total gastrectomy. Conclusions: Although the frequency of malignant transformation is considered to be low in CCS, it has definite malignant potential and a close follow-up examination is recommended.

Protective Effect of Lycopene on Oxidative Stress-Induced Cell Death of Pancreatic Acinar Cells

Seo, Jeong Yeon,Masamune, Atsushi,Shimosegawa, Tooru,Kim, Hyeyoung Wiley (Blackwell Publishing) 2009 Annals of the New York Academy of Sciences Vol.1171 No.1

<P>Previously we showed that the underlying mechanism of oxidative stress-induced apoptosis is nuclear loss of DNA repair protein Ku70 and Ku80, which are involved in the DNA repair process of double-strand breaks. Lycopene acts as an antioxidant and a singlet oxygen quencher. In the present study, we aim to investigate whether lycopene protects oxidative stress-induced cell death of pancreatic acinar AR42J cells by preventing the loss of Ku70 in the nucleus. The cells received oxidative stress caused by glucose oxidase acting on beta-D-glucose (glucose/glucose oxidase) and were cultured in the absence or presence of various concentrations of lycopene. Viable cell numbers, the levels of H(2)O(2) in the medium, level of Ku70 protein, and Ku-DNA-binding activity were determined. As a result, glucose/glucose oxidase induced the decrease in cell viability, increase in H(2)O(2) production, decrease in Ku70 levels in whole-cell extracts and nuclear extracts, and decrease in Ku-DNA-binding activity of AR42J cells. Lycopene inhibited glucose/glucose oxidase-induced cell death by preventing nuclear loss of Ku70 and a decrease in Ku-DNA-binding activity of AR42J cells. In conclusion, lycopene may be beneficial for the treatment of oxidative stress-induced cell death by preventing loss of DNA repair protein Ku70.</P>

Usefulness of Endoscopic Imaging to Visualize Regional Alterations in Acid Secretion of Noncancerous Gastric Mucosa after Helicobacter pylori Eradication

Uno, Kaname,Iijima, Katsunori,Abe, Yasuhiko,Koike, Tomoyuki,Takahashi, Yasushi,Ara, Nobuyuki,Shimosegawa, Tooru The Korean Gastric Cancer Association 2016 Journal of gastric cancer Vol.16 No.3

Purpose: Endoscopic diagnosis of gastric cancer (GC) that emerges after eradication of Helicobacter pylori may be affected by unique morphological changes. Using comprehensive endoscopic imaging, which can reveal biological alterations in gastric mucosa after eradication, previous studies demonstrated that Congo red chromoendoscopy (CRE) might clearly show an acid non-secretory area (ANA) with malignant potential, while autofluorescence imaging (AFI) without drug injection or dyeing may achieve early detection or prediction of GC. We aimed to determine whether AFI might be an alternative to CRE for identification of high-risk areas of gastric carcinogenesis after eradication. Materials and Methods: We included 27 sequential patients with metachronous GC detected during endoscopic surveillance for a mean of 82.8 months after curative endoscopic resection for primary GC and eradication. After their H. pylori infection status was evaluated by clinical interviews and $^{13}C$-urea breath tests, the consistency in the extension of corpus atrophy (e.g., open-type or closed-type atrophy) between AFI and CRE was investigated as a primary endpoint. Results: Inconsistencies in atrophic extension between AFI and CRE were observed in 6 of 27 patients, although CRE revealed all GC cases in the ANA. Interobserver and intraobserver agreements in the evaluation of atrophic extension by AFI were significantly less than those for CRE. Conclusions: We demonstrated that AFI findings might be less reliable for the evaluation of gastric mucosa with malignant potential after eradication than CRE findings. Therefore, special attention should be paid when we clinically evaluate AFI findings of background gastric mucosa after eradication (University Hospital Medical Information Network Center registration number: UMIN000020849).

Usefulness of Endoscopic Imaging to Visualize Regional Alterations in Acid Secretion of Noncancerous Gastric Mucosa after Helicobacter pylori Eradication

Kaname Uno,Katsunori Iijima,Yasuhiko Abe,Tomoyuki Koike,Yasushi Takahashi,Nobuyuki Ara,Tooru Shimosegawa 대한위암학회 2016 Journal of gastric cancer Vol.16 No.3

Purpose: Endoscopic diagnosis of gastric cancer (GC) that emerges after eradication of Helicobacter pylori may be affected by unique morphological changes. Using comprehensive endoscopic imaging, which can reveal biological alterations in gastric mucosa after eradication, previous studies demonstrated that Congo red chromoendoscopy (CRE) might clearly show an acid non-secretory area (ANA) with malignant potential, while autofluorescence imaging (AFI) without drug injection or dyeing may achieve early detection or prediction of GC. We aimed to determine whether AFI might be an alternative to CRE for identification of high-risk areas of gastric carcinogenesis after eradication. Materials and Methods: We included 27 sequential patients with metachronous GC detected during endoscopic surveillance for a mean of 82.8 months after curative endoscopic resection for primary GC and eradication. After their H. pylori infection status was evaluated by clinical interviews and 13C-urea breath tests, the consistency in the extension of corpus atrophy (e.g., open-type or closed-type atrophy) between AFI and CRE was investigated as a primary endpoint. Results: Inconsistencies in atrophic extension between AFI and CRE were observed in 6 of 27 patients, although CRE revealed all GC cases in the ANA. Interobserver and intraobserver agreements in the evaluation of atrophic extension by AFI were significantly less than those for CRE. Conclusions: We demonstrated that AFI findings might be less reliable for the evaluation of gastric mucosa with malignant potential after eradication than CRE findings. Therefore, special attention should be paid when we clinically evaluate AFI findings of background gastric mucosa after eradication (University Hospital Medical Information Network Center registration number: UMIN000020849).

Review : Recent Advances in the Diagnosis and Management of Autoimmune Pancreatitis: Similarities and Differences in Japan and Korea

( Terumi Kamisawa ),( Ji Kon Ryu ),( Myung Hwan Kim ),( Kazuichi Okazaki ),( Tooru Shimosegawa ),( Jae Bock Chung ) 대한소화기학회 2013 Gut and Liver Vol.7 No.4

Two subtypes (types 1 and 2) of autoimmune pancreatitis (AIP) are currently recognized. Type 1 AIP is relate to immunoglobulin G4 (lymphoplasmacytic sclerosing pancreatitis), and type 2 AIP is characterized by neutrophilic infiltration into the epithelium of the pancreatic duct (idiopathic duct-centric pancreatitis). Although type 2 AIP is sometimes observed in the United States and Europe, most cases of AIP in Japan and Korea are type 1. The international consensus diagnostic criteria for AIP were created to be applicable worldwide and to distinguish between the two types of AIP. AIP is diagnosed based on the presence of at least one of the five cardinal features (i.e., imaging, serology, other organ involvement, histology, and response to steroid therapy). Oral steroids are the standard therapy for AIP, but immunomodulatory drugs or rituximab have been successfully used for patients with relapsed AIP in the United States and Europe. Generally, the clinical manifestations and demography of AIP are similar between Japan and Korea. However, there are differences in some aspects of the disease, including the proportion of other organ involvement, the prevalence of type 2 AIP, diagnostic criteria and maintenance therapy between the two countries. (Gut Liver 2013; 7:394-400)