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(Tetsuo Arakawa),(Toshio Watanabe),(Kazunari Tominaga),(Yasuhiro Fujiwara),(Kazuhide Higuchi) 대한소화기학회 1999 SIDDS Vol.5 No.-
The aim of this paper is to review recent data pertaining to mechanisms of ulcer recurrence. Production of inflammatory cytokines is stimulated by ulcerogenic factors such as stress as well as NSAIDs and H. pylori infection. Therefore, the cytokines may be a common key factor to cause ulcer recurrence. When interleukin-1beta or tumor necrosis factor-alpha is administered to rats with healed chronic gastric ulcer, the ulcer recurs at the same site of previous ulcer (ulcer scar site) like most of human peptic ulcers. Excessive macrophages exist at the regenerated mucosa of ulcer scar site compared with normal mucosa adjacent to the site. Monocytes/macrophages are the major cell type responsible for production of inflammatory cytokines that activate leukocytes and stimulate expression of adhesion molecules. Therefore, the accumulation of such cells at the ulcer scar may explain why ulcers tend to recur usually at the same site. Neutrophils may contribute to the final step of recurrence of ulcer because antibody against neutrophils completely inhibits the recurrence caused by IL-1beta. Two possibly mechanisms are concerned: their cytotoxic effects to the mucosal cells via production of active oxygen species, elastase, and TNF-alpha, and microcirculatory disturbance due to neutrophil-endothelial cell interaction.
Review : Overlap in Patients With Dyspepsia/Functional Dyspepsia
( Yasuhiro Fujiwara ),( Tetsuo Arakawa ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2014 Journal of Neurogastroenterology and Motility (JNM Vol.20 No.4
Patients with dyspepsia/functional dyspepsia (FD) show frequent overlapping of other gastrointestinal (GI) diseases, such as irritable bowel syndrome, and non-GI diseases, in addition to internal subgroup overlapping. These overlap patients have more frequent or more severe symptoms, poorer health-related quality of life and higher somatization scores, and they are more likely to experience anxiety, depression or insomnia compared to non-overlap patients. The higher prevalence of overlap in patients with dyspepsia/FD is not by chance, indicating common pathogeneses, including visceral hypersensitivity, altered GI motility, infection, and stressful early life events. There are few clinical trials targeting overlap in patients with dyspepsia/FD, and no therapeutic strategy has been established. Further studies in this research area are needed. In this review, we describe the epidemiology, pathogenesis and treatment of overlap in patients with dyspepsia/FD.
Small Bowel Endoscopy in Inflammatory Bowel Disease
Hirokazu Yamagami,Kenji Watanabe,Noriko Kamata,Mitsue Sogawa,Tetsuo Arakawa 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.4
Crohn disease (CD) is a chronic inflammatory bowel disease that affects the entire gastrointestinal tract but is most frequently localized to the large and small bowel. Small bowel endoscopy helps with the differential diagnosis of CD in suspected CD patients. Early diagnosis of CD is preferable for suspected CD conditions to improve chronic inflammatory infiltrates, fibrosis. Small bowel endoscopy can help with the early detection of active disease, thus leading to early therapy before the onset of clinical symptoms of established CD. Some patients with CD have mucosal inflammatory changes not in the terminal ileum but in the proximal small bowel. Conventional ileocolonoscopy cannot detect ileal involvement proximal to the terminal ileum. Small bowel endoscopy, however, can be useful for evaluating these small bowel involvements in patients with CD. Small bowel endoscopy by endoscopic balloon dilation (EBD) enables the treatment of small bowel strictures in patients with CD. However, many practical issues still need to be addressed, such as endoscopic findings for early detection of CD, application compared with other imaging modalities, determination of the appropriate interval for endoscopic surveillance of small bowel lesions in patients with CD, and long-term prognosis after EBD.