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- 저자 : Yuji Maehata (검색결과 2 건)
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Yuji Maehata,Yutaka Nagata,Tomohiko Moriyama,Yuichi Matsuno,Atsushi Hirano,Junji Umeno,Takehiro Torisu,Tatsuya Manabe,Takanari Kitazono,Motohiro Esaki 대한장연구학회 2019 Intestinal Research Vol.17 No.3
Background/Aims: It remains uncertain which patients with stricturing-type Crohn’s disease (CD) require early small bowel surgery after the initial diagnosis. We aimed to clarify clinical characteristics associated with the intervention in such condition of CD. Methods: We retrospectively evaluated the clinical course of 53 patients with CD and small bowel strictures who were initially treated with medications after the initial diagnosis. We investigated possible associations between small bowel surgery and the following: clinical factors and radiologic findings at initial diagnosis and the types of medications administered during follow-up. Results: Twenty-eight patients (53%) required small bowel resection during a median follow-up period of 5.0 years (range, 0.5–14.3 years). The cumulative incidence rates of small bowel surgery at 2, 5, and 10 years were 26.4%, 41.0%, and 63.2%, respectively. Univariate analysis indicated that obstructive symptoms (P=0.036), long-segment stricture (P<0.0001), and prestenotic dilation (P<0.0001) on radiography were associated with small bowel surgery, and immunomodulatory (P=0.037) and biological therapy (P=0.008) were significant factors during follow-up. Multivariate analysis revealed that long-segment stricture (hazard ratio [HR], 4.25; 95% confidence interval [CI], 1.78–10.53; P=0.001) and prestenotic dilation (HR, 3.41; 95% CI, 1.24–9.62; P=0.018) on radiography showed a positive correlation with small bowel surgery, and biological therapy (HR, 0.40; 95% CI, 0.15–0.99; P=0.048) showed a negative correlation. Conclusions: CD patients with long-segment stricture and prestenotic dilation on radiography seem to be at a higher risk of needing small bowel surgery. For such patients, early surgical intervention might be appropriate, even at initial diagnosis.
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( Yuji Maehata ),( Shotaro Nakamura ),( Motohiro Esaki ),( Fumie Ikeda ),( Tomohiko Moriyama ),( Risa Hida ),( Ema Washio ),( Junji Umeno ),( Minako Hirahashi ),( Takanari Kitazono ),( Takayuki Matsum 대한간학회 2017 Gut and Liver Vol.11 No.5
Background/Aims: Gastric cancers develop even after suc-cessful Helicobacter pylori eradication. We aimed to clarify the characteristics of early gastric cancers discovered after H. pylori eradication. Methods: A total of 1,053 patients with early gastric cancer treated by endoscopic submucosal dis-section were included. After matching the propensity score, we retrospectively investigated the clinicopathological fea-tures of 192 patients, including 96 patients who had under-gone successful H. pylori eradication (Hp-eradicated group) and 96 patients who had active H. pylori infection (Hp-positive group). Results: In the Hp-eradicated group, early gastric cancers were discovered 1 to 15 years (median, 4.1 years) after H. pylori eradication. Compared with Hp-positive pa-tients, Hp-eradicated patients showed a more frequently de-pressed configuration (81% vs 53%, respectively, p<0.0001) and a higher trend toward submucosal invasion (18% vs 8%, respectively, p=0.051). A multivariable analysis revealed the macroscopic depressed type to be characteristics of early gastric cancers after H. pylori eradication. Among patients in the Hp-eradicated group, metachronous cancers showed less frequent depressed lesions (68% vs 84%, respectively, p=0.049) and smaller tumor sizes (median, 11 mm vs 14 mm, respectively, p=0.014) than primary cancers. Conclu-sions: Early gastric cancers after H. pylori eradication are characterized by a depressed configuration. Careful follow- up endoscopies are necessary after H. pylori eradication. (Gut Liver 2017;11:628-634)
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