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Nambu R, Kudo T, Tachibana N, Shimizu H, Mizuochi T, Kato S, Inoue M, Kumagai H, Ishige T, Kunisaki R, Noguchi A, Yodoshi T, Hagiwara SI, Nishimata S, Kakuta F, Saito T, Iwama I, Hirano Y, Shimizu T, Arai K. Prognosis of pediatric ulcerative colitis after infliximab failure: A multicenter registry-based cohort study. J Gastroenterol Hepatol 2024; 39:312-318. [PMID: 38058020 DOI: 10.1111/jgh.16431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND AIM Even with increasing numbers of biologic agents available for management of ulcerative colitis (UC), infliximab (IFX) retains an important place in treatment of pediatric patients with this disease. As few reports have addressed outcomes in pediatric UC patients who had to discontinue IFX, we examined clinical course and prognosis after IFX failure in pediatric UC. METHODS A prospective cohort study of pertinent cases enrolled in the Japanese Pediatric Inflammatory Bowel Disease Registry between 2012 and 2020 was conducted to determine outcomes for pediatric UC patients who received IFX but required its discontinuation during follow-up (IFX failure). RESULTS Of the 301 pediatric UC patients in the registry, 75 were treated with IFX; in 36 of these, IFX was discontinued during follow-up. Severity of UC at onset and absence of concomitant immunomodulator therapy were significant risk factors for IFX failure (P = 0.005 and P = 0.02, respectively). The cumulative colectomy rate after IFX failure was 41.3% at 1 year and 47.5% at 2 years. Colectomy was significantly more frequent when IFX was discontinued before June 1, 2018, than when IFX was discontinued later (P = 0.013). This difference likely involves availability of additional biologic agents for treatment of UC beginning in mid-2018 (P = 0.005). CONCLUSION In pediatric UC patients, approximately 50% underwent colectomy during a 2-year interval following IFX failure. Prognosis after IFX failure appeared to improve with availability of new biologic agents and small-molecule drugs in mid-2018.
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Affiliation(s)
- Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Nao Tachibana
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hirotaka Shimizu
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, School of Medicine, Kurume University, Fukuoka, Japan
| | - Sawako Kato
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
| | - Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University, Tsu, Japan
- Department of Pediatric Surgery, Fujita Health University, Toyoake, Japan
| | - Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Takashi Ishige
- Department of Pediatrics, School of Medicine, Gunma University Graduate, Maebashi, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Atsuko Noguchi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | | | - Shin-Ichiro Hagiwara
- Department of Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Shigeo Nishimata
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Fumihiko Kakuta
- Department of General Pediatrics and Gastroenterology, Miyagi Children's Hospital, Sendai, Japan
| | - Takeshi Saito
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
- Division of Pediatric Surgery, Chiba Children's Hospital, Chiba, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Yuri Hirano
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Katsuhiro Arai
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
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Nambu R, Miyazawa A, Yoshida M, Hara T, Iwama I. Long-term Efficacy and Safety of Tacrolimus Plus Ustekinumab Combination Therapy in Children With Steroid-refractory Ulcerative Colitis. Inflamm Bowel Dis 2024:izae013. [PMID: 38267832 DOI: 10.1093/ibd/izae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Ayako Miyazawa
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Masashi Yoshida
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Tomoko Hara
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
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Yokoyama K, Yamamoto Y, Nambu R, Hagiwara SI, Abukawa D, Mizuochi T, Kudo T, Sado T, Iwata N, Ishige T, Iwama I, Kumagai H, Arai K, Shimizu T. Safety and efficacy of vedolizumab in pediatric patients with ulcerative colitis: multicenter study in Japan. J Gastroenterol Hepatol 2023. [PMID: 37278369 DOI: 10.1111/jgh.16246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/20/2023] [Accepted: 05/20/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Vedolizumab (VDZ) is a humanized monoclonal antibody that binds to α4β7 integrin expressed in T-lymphocytes and is gut selective. Few studies have evaluated the safety and efficacy of VDZ in pediatric ulcerative colitis (UC) patients, especially from Asia. METHODS A longitudinal multicenter retrospective study was conducted at 10 Japanese tertiary medical institutions. Patients aged ≤18 years old who received VDZ for UC between January 2019 and July 2021 were enrolled. Information on the clinical characteristics, prior/concomitant treatment, and safety during the observation period was collected. RESULTS The data obtained from 48 patients (males, n = 30; females, n = 18) were analyzed. The median age at VDZ induction was 14 (range 4-18) years old. VDZ was indicated in 73% of patients as switching from previous biologics due to primary failure, loss of response, and adverse events (AEs) and was the first biologic in 27%. Remission was achieved or maintained at weeks 14, 30, and 54 in 79.2%, 75.0%, and 65.8% of patients, respectively. There were no significant differences between the number of previous biologics exposures and VDZ effectiveness. The hematocrit, serum albumin concentrations, and erythrocyte sedimentation rate (ESR) at baseline differed significantly by VDZ effectiveness. Nine AEs, including infusion reaction, were noted in seven (14.3%) patients. There were no severe AEs related to VDZ administration. CONCLUSIONS VDZ was safe and effective in children with UC. The hematocrit, albumin, and ESR at VDZ initiation might be predictors for VDZ effectiveness. VDZ may be an important option for pediatric patients and can be used as an alternative to immunomodulators.
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Affiliation(s)
- Koji Yokoyama
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yoko Yamamoto
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Shin-Ichiro Hagiwara
- Department of Gastroenterology and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Daiki Abukawa
- Department of Gastroenterology and Hepatology, Miyagi Children's Hospital, Sendai, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tomomitsu Sado
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naomi Iwata
- Division of Infectious Disease and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Hideki Kumagai
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
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Hosokawa T, Tanami Y, Sato Y, Deie K, Ishimaru T, Hara T, Nambu R, Deguchi K, Takei H, Iwama I, Kawashima H, Oguma E. Incidence and diagnostic performance of ultrasound for perianal abscess or fistula-in-ano in pediatric patients with perianal inflammation. J Clin Ultrasound 2023; 51:819-826. [PMID: 36870044 DOI: 10.1002/jcu.23446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To describe the incidence and diagnostic performance of ultrasound for perianal abscess or fistula-in-ano in pediatric patients with perianal inflammation. METHODS We included 45 patients with perianal inflammation who underwent ultrasonography. To demonstrate the diagnostic performance of ultrasound for fistula-in-ano, a definite diagnosis of perianal abscess, and fistula-in-ano was determined as that proven through magnetic resonance imaging (MRI) or computed tomography (CT). The absence or presence of perianal abscess and fistula-in-ano on ultrasonography was recorded. RESULTS Among the 45 patients, on ultrasound, perianal abscess and fistula-in-ano were detected in 22 (48.9%) and 30 (68.2%) patients, respectively. Nine patients had MRI or CT and a definite diagnosis of perianal abscess or fistula-in-ano; accuracy, negative predictive value, and positive predictive value of ultrasound for perianal abscess were 77.8% (7/9; 95% confidence interval [CI]: 40.0%-97.1%), 66.7% (2/3; 95% CI: 9.4%-99.2%), 83.3% (5/6; 95% CI: 35.9%-99.6%), and those of fistula-in-ano were 100% (9/9; 95% CI: 66.4%-100%), 100% (8/8; 95% CI: 63.1%-100%), and 100% (1/1; 95% CI: 2.5%-100%), respectively. CONCLUSIONS Perianal abscess and fistula-in-ano were detected by ultrasound in half of the patients with perianal inflammation. Accordingly, ultrasound has an acceptable diagnostic performance for perianal abscess and fistula-in-ano.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Kyoichi Deie
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Ishimaru
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Tomoko Hara
- Department of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Ryusuke Nambu
- Department of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Kuntaro Deguchi
- Department of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Haruka Takei
- Department of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Itaru Iwama
- Department of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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Miyazawa A, Nambu R, Yoshida M, Hosokawa T, Iwama I. Ingested Nasopharyngeal Swab for Viral Testing Retained in a Child's Duodenum. JPGN Rep 2023; 4:e295. [PMID: 37200729 PMCID: PMC10187846 DOI: 10.1097/pg9.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/14/2022] [Indexed: 05/20/2023]
Affiliation(s)
- Ayako Miyazawa
- From the Division of Gastroenterology and Hepatology, Saitama Children’s Medical Center, Saitama, Japan
| | - Ryusuke Nambu
- From the Division of Gastroenterology and Hepatology, Saitama Children’s Medical Center, Saitama, Japan
| | - Masashi Yoshida
- From the Division of Gastroenterology and Hepatology, Saitama Children’s Medical Center, Saitama, Japan
| | - Takahiro Hosokawa
- Department of Radiology, Saitama Children’s Medical Center, Saitama, Japan
| | - Itaru Iwama
- From the Division of Gastroenterology and Hepatology, Saitama Children’s Medical Center, Saitama, Japan
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6
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Tanaka Y, Inage E, Matsumoto M, Murano Y, Endo A, Nakabayashi Y, Yokoya S, Iwama I, Suzuki Y, Oyama S, Baba Y, Kudo T, Ohtsuka Y, Shimizu T. Low billing rates for pediatric sedation fee on magnetic resonance imaging. Pediatr Int 2023; 65:e15532. [PMID: 36942824 DOI: 10.1111/ped.15532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Sedating children for magnetic resonance imaging (MRI) requires special consideration. The 2018 revision of social insurance allows additional fees to be calculated for pediatric MRIs performed under sedation in Japan. The number and trend of actual claims since this addition was established is unknown. METHODS To analyze the claims of additional fees for pediatric sedated MRI imaging after fiscal year (FY) 2018, the actual claims of the addition in inpatient and outpatient practice was analyzed using publicly-available data from the Ministry of Health, Labour and Welfare (MHLW). We analyzed the calculation rate for all MRI scans. Annual changes in the actual number and calculation rate were analyzed. The ratio of the number of additional fees to the overall number of pediatric radiological procedures was used to examine the geographic disparity. RESULTS The number of calculations from FY 2018 to FY 2020 was available; in FY 2020, only 1347 additions were calculated, corresponding to 0.35% of the total number of MRI scans. The number of fees showed a decreasing trend. Most cases were in the 0-4 years age group: however, there were a few cases in the 10-14 years age group without such a decrease. The relative number of calculations by prefecture showed a disparity of up to 14 times. CONCLUSIONS The requirements for the addition of pediatric MRI sedation are strict and not fully utilized in pediatric sedation for MRI. Measures such as relaxing the requirements for the fee are needed to make MRI-related sedation safer. (249/250words) .
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Affiliation(s)
- Yuko Tanaka
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Eisuke Inage
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Megumi Matsumoto
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yayoi Murano
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akifumi Endo
- Department of Pediatrics, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
| | - Yosuke Nakabayashi
- Advanced Medical Emergency Department & Critical Care Center, Japanese Red Cross Maebashi Hospital, Gunma, Japan
| | - Susumu Yokoya
- Thyroid and Endocrine Center, Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, Japan
| | - Itaru Iwama
- Devision of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Yasuyuki Suzuki
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Shoichi Oyama
- Department of Pediatrics, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Yosuke Baba
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takahiro Kudo
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshikazu Ohtsuka
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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7
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Nambu R, Arai K, Kudo T, Murakoshi T, Kunisaki R, Mizuochi T, Kato S, Kumagai H, Inoue M, Ishige T, Saito T, Noguchi A, Yodoshi T, Hagiwara SI, Iwata N, Nishimata S, Kakuta F, Tajiri H, Hiejima E, Toita N, Mochizuki T, Shimizu H, Iwama I, Hirano Y, Shimizu T. Clinical outcome of ulcerative colitis with severe onset in children: a multicenter prospective cohort study. J Gastroenterol 2023; 58:472-480. [PMID: 36884071 DOI: 10.1007/s00535-023-01972-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/14/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND As best practices for treating children with severe-onset ulcerative colitis remain controversial in the era of biologic agents, we prospectively investigated treatments and outcomes in a multicenter cohort. METHODS Using a Web-based data registry maintained in Japan between October 2012 and March 2020, we compared management and treatment outcomes in an S1 group defined by a Pediatric Ulcerative Colitis Activity Index of 65 or more points at diagnosis with those in an S0 group defined by an index value below 65. RESULTS Three hundred one children with ulcerative colitis treated at 21 institutions were included, with follow-up for 3.6 ± 1.9 years. Among them, 75 (25.0%) were in S1; their age at diagnosis was 12.3 ± 2.9 years, and 93% had pancolitis. Colectomy free rates in S1 were 89% after 1 year, 79% after 2, and 74% after 5, significantly lower than for S0 (P = 0.0003). Calcineurin inhibitors and biologic agents, respectively, were given to 53% and 56% of S1 patients, significantly more than for S0 patients (P < 0.0001). Among S1 patients treated with calcineurin inhibitors when steroids failed, 23% required neither biologic agents nor colectomy, similarly to the S0 group (P = 0.46). CONCLUSIONS Children with severe ulcerative colitis are likely to require powerful agents such as calcineurin inhibitors and biologic agents; sometimes colectomy ultimately proves necessary. Need for biologic agents in steroid-resistant patients might be reduced to an extent by interposing a therapeutic trial of CI rather than turning to biologic agents or colectomy immediately.
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Affiliation(s)
- Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-Ku, Saitama, 3308777, Japan.
| | - Katsuhiro Arai
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Takatsugu Murakoshi
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Kanagawa, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Sawako Kato
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
| | - Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Mikihiro Inoue
- Department of Pediatric Surgery, Fujita Health University, Aichi, Japan
| | - Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takeshi Saito
- Division of Pediatric Surgery, Chiba Children's Hospital, Chiba, Japan
| | - Atsuko Noguchi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | | | - Shin-Ichiro Hagiwara
- Department of Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Shigeo Nishimata
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Fumihiko Kakuta
- Department of General Pediatrics and Gastroenterology, Miyagi Children's Hospital, Miyagi, Japan
| | - Hitoshi Tajiri
- Department of Pediatrics, Osaka General Medical Center, Osaka, Japan
| | - Eitaro Hiejima
- Department of Pediatrics, Kyoto University Hospital, Kyoto, Japan
| | - Nariaki Toita
- Department of Pediatrics, Sapporo Kosei General Hospital, Hokkaido, Japan
| | | | - Hirotaka Shimizu
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-Ku, Saitama, 3308777, Japan
| | - Yuri Hirano
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
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8
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Ishige T, Shimizu T, Watanabe K, Arai K, Kamei K, Kudo T, Kunisaki R, Tokuhara D, Naganuma M, Mizuochi T, Murashima A, Inoki Y, Iwata N, Iwama I, Koinuma S, Shimizu H, Jimbo K, Takaki Y, Takahashi S, Cho Y, Nambu R, Nishida D, Hagiwara SI, Hikita N, Fujikawa H, Hosoi K, Hosomi S, Mikami Y, Miyoshi J, Yagi R, Yokoyama Y, Hisamatsu T. Correction to: Expert consensus on vaccination in patients with inflammatory bowel disease in Japan. J Gastroenterol 2023; 58:431-432. [PMID: 36763141 PMCID: PMC10050021 DOI: 10.1007/s00535-023-01965-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, 3-39-22, Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenji Watanabe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Makoto Naganuma
- Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Atsuko Murashima
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center of Child Health and Development, Tokyo, Japan
| | - Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Sachi Koinuma
- Japan Drug Information Institute in Pregnancy, National Center of Child Health and Development, Tokyo, Japan
| | - Hirotaka Shimizu
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Keisuke Jimbo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yugo Takaki
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Shohei Takahashi
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
| | - Yuki Cho
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Daisuke Nishida
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin-Ichiro Hagiwara
- Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Norikatsu Hikita
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Fujikawa
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Hosoi
- Division of Gastroenterology, Tokyo Metro Children's Medical Center, Tokyo, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yohei Mikami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Jun Miyoshi
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryusuke Yagi
- Department of Pediatrics, Gunma University Graduate School of Medicine, 3-39-22, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Yoko Yokoyama
- Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
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9
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Ishige T, Shimizu T, Watanabe K, Arai K, Kamei K, Kudo T, Kunisaki R, Tokuhara D, Naganuma M, Mizuochi T, Murashima A, Inoki Y, Iwata N, Iwama I, Koinuma S, Shimizu H, Jimbo K, Takaki Y, Takahashi S, Cho Y, Nambu R, Nishida D, Hagiwara SI, Hikita N, Fujikawa H, Hosoi K, Hosomi S, Mikami Y, Miyoshi J, Yagi R, Yokoyama Y, Hisamatsu T. Expert consensus on vaccination in patients with inflammatory bowel disease in Japan. J Gastroenterol 2023; 58:135-157. [PMID: 36629948 PMCID: PMC9838549 DOI: 10.1007/s00535-022-01953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023]
Abstract
Immunosuppressive therapies can affect the immune response to or safety of vaccination in patients with inflammatory bowel disease (IBD). The appropriateness of vaccination should be assessed prior to the initiation of IBD treatment because patients with IBD frequently undergo continuous treatment with immunosuppressive drugs. This consensus was developed to support the decision-making process regarding appropriate vaccination for pediatric and adult patients with IBD and physicians by providing critical information according to the published literature and expert consensus about vaccine-preventable diseases (VPDs) [excluding cervical cancer and coronavirus disease 2019 (COVID-19)] in Japan. This consensus includes 19 important clinical questions (CQs) on the following 4 topics: VPDs (6 CQs), live attenuated vaccines (2 CQs), inactivated vaccines (6 CQs), and vaccination for pregnancy, childbirth, and breastfeeding (5 CQs). These topics and CQs were selected under unified consensus by the members of a committee on intractable diseases with support by a Health and Labour Sciences Research Grant. Physicians should provide necessary information on VPDs to their patients with IBD and carefully manage these patients' IBD if various risk factors for the development or worsening of VPDs are present. This consensus will facilitate informed and shared decision-making in daily IBD clinical practice.
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Affiliation(s)
- Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, 3-39-22, Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenji Watanabe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Makoto Naganuma
- Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Atsuko Murashima
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center of Child Health and Development, Tokyo, Japan
| | - Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Sachi Koinuma
- Japan Drug Information Institute in Pregnancy, National Center of Child Health and Development, Tokyo, Japan
| | - Hirotaka Shimizu
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Keisuke Jimbo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yugo Takaki
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Shohei Takahashi
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
| | - Yuki Cho
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Daisuke Nishida
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin-Ichiro Hagiwara
- Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Norikatsu Hikita
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Fujikawa
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Hosoi
- Division of Gastroenterology, Tokyo Metro Children's Medical Center, Tokyo, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yohei Mikami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Jun Miyoshi
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryusuke Yagi
- Department of Pediatrics, Gunma University Graduate School of Medicine, 3-39-22, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Yoko Yokoyama
- Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
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10
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Matsumoto T, Umeno J, Jimbo K, Arai M, Iwama I, Kashida H, Kudo T, Koizumi K, Sato Y, Sekine S, Tanaka S, Tanakaya K, Tamura K, Hirata K, Fukahori S, Esaki M, Ishikawa H, Iwama T, Okazaki Y, Saito Y, Matsuura N, Mutoh M, Tomita N, Akiyama T, Yamamoto T, Ishida H, Nakayama Y. Clinical Guidelines for Diagnosis and Management of Juvenile Polyposis Syndrome in Children and Adults-Secondary Publication. J Anus Rectum Colon 2023; 7:115-125. [PMID: 37113581 PMCID: PMC10129355 DOI: 10.23922/jarc.2023-002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/16/2023] [Indexed: 04/29/2023] Open
Abstract
Juvenile polyposis syndrome (JPS) is a rare disease characterized by multiple hamartomatous polyps within the gastrointestinal tract. SMAD4 or BMPR1A is known as a causative gene of JPS. Approximately 75% of newly diagnosed cases have an autosomal-dominantly inherited condition, whereas 25% are sporadic without previous history of polyposis in the family pedigree. Some patients with JPS develop gastrointestinal lesions in childhood and require continuous medical care until adulthood. JPS is classified into three categories according to phenotypic features of polyp distributions, including generalized juvenile polyposis, juvenile polyposis coli, and juvenile polyposis of the stomach. Juvenile polyposis of the stomach is caused by germline pathogenic variants of SMAD4 with a high risk leading to gastric cancer. Pathogenic variants of SMAD4 are also associated with hereditary hemorrhagic telangiectasia-JPS complex, inducing regular cardiovascular survey. Despite growing concerns regarding the managing JPS in Japan, there are no practical guidelines. To address this situation, the guideline committee was organized by the Research Group on Rare and Intractable Diseases granted by the Ministry of Health, Labor and Welfare involving specialists from multiple academic societies. The present clinical guidelines explain the principles in the diagnosis and management of JPS with three clinical questions and corresponding recommendations based on a careful review of the evidence and involve incorporating the concept of the Grading of Recommendations, Assessment, Development, and Evaluation system. Herein, we present the clinical practice guidelines of JPS to promote seamless implementation of accurate diagnosis and appropriate management of pediatric, adolescent, and adult patients with JPS.
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Affiliation(s)
- Takayuki Matsumoto
- Division of Gastroenterology, Department of Medicine, Iwate Medical University, Morioka, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keisuke Jimbo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masami Arai
- Department of Clinical Genetics, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Koichi Koizumi
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yasushi Sato
- Department of Community Medicine for Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shigeki Sekine
- Division of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kohji Tanakaya
- Department of Surgery, Iwakuni Clinical Center, Iwakuni, Japan
| | - Kazuo Tamura
- Division of Genetic Medicine, Graduate School of Science and Engineering Research, Kindai University, Higashiosaka, Japan
| | - Keiji Hirata
- Department of Surgery 1, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Suguru Fukahori
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Ishikawa Gastroenterology Clinic, Osaka, Japan
| | - Takeo Iwama
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yasushi Okazaki
- Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Michihiro Mutoh
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naohiro Tomita
- Cancer Treatment Center, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Takashi Akiyama
- Department of Pediatric Surgery, Chuden Hospital, Hiroshima, Japan
| | - Toshiki Yamamoto
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yoshiko Nakayama
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
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11
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Iwama I, Nambu R, Nakayama Y. Small bowel endoscopy for children: Collaboration of capsule endoscopy and device-assisted enteroscopy. Dig Endosc 2022. [PMID: 36576231 DOI: 10.1111/den.14511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
Capsule endoscopy (CE) and balloon-assisted enteroscopy (BAE) have become indispensable techniques for the diagnosis and management of small bowel disease in both adult and pediatric cases. However, relevant differences exist in the indications between these cohorts, with body weight and age having particular relevance in decisions for the latter. Both CE and BAE are designed for adult physique and they were not widely used among children. In addition, the types of small intestinal diseases differ between adults and children, and consequently, the indications also differ between them. This review focuses on the issues relevant to pediatric cases and describes the practical application of endoscopy in clinical practice. In conclusion, although there are age and weight restrictions, both CE and BAE are safe and useful devices for use in children, and their indications for use in children are likely to expand in the future.
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Affiliation(s)
- Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshiko Nakayama
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
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12
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Hosokawa T, Tanami Y, Sato Y, Nambu R, Iwama I, Oguma E. Role of ultrasound in the diagnosis of very early-onset inflammatory bowel disease in children: a report of three cases. Med Ultrason 2022; 24:491-495. [PMID: 34762726 DOI: 10.11152/mu-3273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Very early-onset inflammatory bowel disease (VEO-IBD) is defined as IBD onset before 6 years of age and some cases are caused by unique monogenic disorders that require specific treatments such as stem cell transplantation. We identified three children with VEO-IBD of whom two had monogenic disorders. In cases 1 and 2, ultrasound revealed isolated colonic distribution and the loss of wall stratification. In case 3, mesentery inflammation was evident. Bowel ultrasound showed variable findings due to differences in the inflammation distribution within the bowel. In order to diagnose VEO-IBD, sonographersshould carefully evaluate the intestinal wall thickness and stratification and the distribution of inflammation in the intestine and mesentery. These findings may aid the diagnosis of VEO-IBD.
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Affiliation(s)
- Takahiro Hosokawa
- Department of radiology, saitama children medical center, saitama, japan.
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13
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Horiguchi A, Arakawa Y, Noguchi J, Mori M, Oshima K, Iwama I, Kawashima H, Tanami Y, Nakazawa A, Koh K. Donor-origin anaplastic lymphoma kinase driver-positive inflammatory myofibroblastic tumor after umbilical cord blood transplantation in pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer 2022; 69:e29708. [PMID: 35441453 DOI: 10.1002/pbc.29708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Ayumi Horiguchi
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Yuki Arakawa
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Jun Noguchi
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Makiko Mori
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Koichi Oshima
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Itaru Iwama
- Department of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Atsuko Nakazawa
- Department of Clinical Research, Saitama Children's Medical Center, Saitama, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
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14
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Meguro M, Nambu R, Hara T, Ebana R, Yoshida M, Yamamoto S, Mori K, Iwama I. Clostridioides difficile Infection in a Japanese Tertiary Children's Hospital. Pediatr Gastroenterol Hepatol Nutr 2022; 25:387-395. [PMID: 36148292 PMCID: PMC9482825 DOI: 10.5223/pghn.2022.25.5.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/06/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Toxins produced by Clostridioides difficile infection (CDI) can cause enteritis and diarrhea. Although the number of pediatric CDI cases is increasing, the clinical management of pediatric CDI, including patient characteristics and prognosis, remains unclear. This study aimed to elucidate the background and clinical course of patients with CDI and evaluate the reliability of diagnostic tests in a tertiary pediatric hospital in Japan. METHODS We retrospectively analyzed the clinical data of children diagnosed with CDI between 2011 and 2021 at the Saitama Children's Medical Center in Saitama, Japan. RESULTS During the study period, 1,252 C. difficile antigen/toxin tests were performed, and 37 patients were diagnosed with CDI. The main underlying diseases among the patients were hematological and malignant disorders and gastrointestinal diseases, including inflammatory bowel disease (IBD) (59.4%). Two patients (5.4%) had an unremarkable medical history. Among the 37 patients, 27 (73.0%) were immunocompromised, 25 (67.6%) had a history of antibiotic use within the past two months, and 6 (16.2%) were negative on the initial test but were positive on the second test. Finally, 28 patients (75.7%) required primary antibiotic therapy only, and two patients with IBD required additional antibiotic therapy as secondary treatment. CONCLUSION The number of pediatric patients with CDI is increasing. Both a comprehensive interview, including underlying diseases and history of antibiotic use, and an understanding of the features of clinical examinations should be emphasized to appropriately diagnose and treat CDI.
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Affiliation(s)
- Mariko Meguro
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Tomoko Hara
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Ryo Ebana
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Masashi Yoshida
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Saki Yamamoto
- Department of Laboratory Technology, Saitama Children's Medical Center, Saitama, Japan
| | - Koki Mori
- Department of Laboratory Technology, Saitama Children's Medical Center, Saitama, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
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15
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Yoshida M, Nambu R, Yasuda R, Sakaguchi H, Hara T, Iwama I, Mizuochi T. Dapsone for Refractory Gastrointestinal Symptoms in Children With Immunoglobulin A Vasculitis. Pediatrics 2022; 150:188779. [PMID: 35975615 DOI: 10.1542/peds.2021-055884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
Immunoglobulin A vasculitis (IgAV) is a systemic small-vessel vasculitis. Although corticosteroids (CS) are the primary treatment for gastrointestinal manifestations associated with IgAV, some patients develop refractory or recurrent symptoms such as vomiting and abdominal pain despite CS treatment. Dapsone, a synthetic sulfone antimicrobial, has been used to treat cutaneous purpura in IgAV, but few authors have reported its use for refractory gastrointestinal symptoms. In this retrospective observational study, we describe results in 7 children with IgAV who were treated with dapsone for abdominal pain resistant to CS. Dapsone rapidly relieved abdominal pain in all 7 patients, who then were tapered off CS without relapse. Side effects of mild methemoglobinemia and hemolysis appeared to be manageable with planned monitoring and dose adjustment; a single patient who discontinued dapsone had fatigue and hypoxia associated with methemoglobinemia. No side effects were life-threatening. Dapsone may be considered as a therapeutic option for gastrointestinal symptoms refractory to CS in children with IgAV.
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Affiliation(s)
- Masashi Yoshida
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan.,These authors contributed equally to this work
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan.,These authors contributed equally to this work
| | - Ryosuke Yasuda
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Hirotaka Sakaguchi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Tomoko Hara
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan.,These authors contributed equally to this work
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16
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Hara T, Iwama I, Hosokawa T, Nambu R. Successful Endoscopic Reduction of Gastric Volvulus in 2 Children: Acute and Chronic Cases. J Pediatr Gastroenterol Nutr 2022; 75:e30. [PMID: 35869904 DOI: 10.1097/mpg.0000000000003432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
| | | | - Takahiro Hosokawa
- the Division of Radiology, Saitama Children's Medical Center, Saitama, Japan
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17
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Shimizu H, Ebana R, Kudo T, Sato T, Hara T, Hosoi K, Usami M, Yoshida M, Takeuchi I, Nakase H, Iwama I, Arai K, Shimizu T. Both fecal calprotectin and fecal immunochemical tests are useful in children with inflammatory bowel disease. J Gastroenterol 2022; 57:344-356. [PMID: 35165800 DOI: 10.1007/s00535-022-01856-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/25/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Noninvasive biomarkers of intestinal inflammation can reduce the number of endoscopies in children with inflammatory bowel disease (IBD). This study aimed to prospectively investigate the usefulness of fecal calprotectin (FCP) and fecal immunochemical test (FIT) in pediatric IBD. METHODS Patients aged 6-17 years who underwent ileocolonoscopy for established or suspected IBD were eligible for this study. Fecal samples for FCP and FIT were collected before colonoscopy. RESULTS A total of 251 samples were analyzed: 88 from ulcerative colitis (UC), 74 from Crohn's disease (CD), 75 from healthy controls (HC), and 14 from children with functional gastrointestinal disorders and normal colonoscopy (NC). At IBD diagnosis, both FCP and FIT were significantly higher in the newly diagnosed UC/CD group than in the HC/NC group (P < 0.001). The optimal cutoffs of FCP and FIT to predict IBD diagnosis were 217 mg/kg and 87 ng/mL, respectively. Patients without mucosal healing (MH) showed higher FCP and FIT than those with MH in both UC and CD (P < 0.001). The FCP increased exponentially as the endoscopic activity score increased. The optimal cutoff values of FCP and FIT for predicting MH were 161 mg/kg and 106 ng/mL for UC and 367 mg/kg and 57 ng/mL for CD, respectively. FCP showed better specificity than the FIT. Patients with CD and normal ileocolonoscopy had elevated FCP during active small intestinal inflammation. CONCLUSIONS Both FCP and FIT correlate well with endoscopic activity in pediatric patients with IBD. The FCP is a superior marker for predicting MH.
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Affiliation(s)
- Hirotaka Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Ryo Ebana
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama, 330-8777, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takuro Sato
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Tomoko Hara
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama, 330-8777, Japan
| | - Kenji Hosoi
- Department of Pediatrics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masaaki Usami
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masashi Yoshida
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama, 330-8777, Japan
| | - Ichiro Takeuchi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, 060-8543, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuou-ku, Saitama, 330-8777, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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18
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Sakaguchi H, Konishi KI, Yasuda R, Sasaki H, Yoshimaru K, Tainaka T, Fukahori S, Sanada Y, Iwama I, Shoji H, Kinoshita M, Matsuura T, Fujishiro J, Uchida H, Nio M, Yamashita Y, Mizuochi T. Serum matrix metalloproteinase-7 in biliary atresia: A Japanese multicenter study. Hepatol Res 2022; 52:479-487. [PMID: 35106887 DOI: 10.1111/hepr.13753] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Biliary atresia (BA) is among the commonest indications for liver transplantation (LT) in children. We examined whether serum matrix metalloproteinase-7 (MMP-7) is useful for diagnosis of BA in Japanese infants, and whether serum MMP-7 concentrations before and after Kasai portoenterostomy (KP) predicted LT within a year. METHODS Subjects under 6 months old at eight pediatric centers in Japan were enrolled retrospectively, including patients with cholestasis and normal controls (NC) without liver disease. Patients with cholestasis were divided into groups representing BA versus cholestasis from other causes (non-BA). Serum samples were collected from patients with BA at diagnosis and 1 and 4 weeks after KP, as well as from non-BA and NC. RESULTS Serum MMP-7 concentrations were significantly higher in BA at diagnosis (median, 89.1 ng/ml) than in non-BA (11.0; p < 0.001) or NC (10.3; p < 0.001). Receiver operating characteristic (ROC) analysis of MMP-7 for BA versus non-BA yielded an area under the ROC curve of 0.99 (95% confidence interval, 0.96-1.00). An optimal cut-off value of 18.6 ng/ml for serum MMP-7 in diagnosing BA demonstrated sensitivity and specificity of 100% and 90%, respectively. Serum MMP-7 before and 1 week and 4 weeks after KP did not differ significantly between BA requiring only KP and BA requiring LT after KP. CONCLUSION Serum MMP-7 is a useful marker for diagnosis of BA in Japanese infants, but it could not predict LT within a year.
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Affiliation(s)
- Hirotaka Sakaguchi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Ken-Ichiro Konishi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan.,Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Yasuda
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Hideyuki Sasaki
- Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichiro Yoshimaru
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Suguru Fukahori
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yukihiro Sanada
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiromichi Shoji
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masahiro Kinoshita
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Toshiharu Matsuura
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Nio
- Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yushiro Yamashita
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
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19
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Nambu R, Warner N, Mulder DJ, Kotlarz D, McGovern DPB, Cho J, Klein C, Snapper SB, Griffiths AM, Iwama I, Muise AM. A Systematic Review of Monogenic Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2022; 20:e653-e663. [PMID: 33746097 PMCID: PMC8448782 DOI: 10.1016/j.cgh.2021.03.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Advances in genomic technologies have led to increasing reports of monogenic inflammatory bowel disease (IBD). Here, we systematically review the literature to determine the clinical features, genetic profile, and previously used treatment strategies in monogenic IBD. METHODS A systematic review of MEDLINE articles published between January 2000 and December 2020 was conducted. A total of 750 individual monogenic IBD cases were identified from 303 eligible articles. RESULTS The most frequently reported monogenic IBD genes were IL10RA/B, XIAP, CYBB, LRBA, and TTC7A. In total, 63.4% of patients developed IBD before 6 years of age, 17.4% developed IBD between ages 10 and 17.9 years, and 10.9% developed IBD after age 18. There was a substantial difference between these age groups and the underlying monogenic disorders. Only 31.7% had any history of extraintestinal comorbidity (EIC) before IBD onset, but 76.0% developed at least 1 EIC during their clinical course. The most common EICs were atypical infection (44.7%), dermatologic abnormality (38.4%), and autoimmunity (21.9%). Bowel surgery, biologic therapy, and hematopoietic stem cell transplantation were performed in 27.1%, 32.9%, and 23.1% of patients, respectively. CONCLUSIONS Monogenic IBD cases, although rare, have varied extraintestinal comorbidities and limited treatment options including surgery and transplant. Early identification and improved understanding of the characteristics of the genes and underlying disease processes in monogenic IBD is important for effective management.
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Affiliation(s)
- Ryusuke Nambu
- SickKids Inflammatory Bowel Disease Centre, the Hospital for Sick Children, Toronto, Canada,Cell Biology Program, Research Institute, the Hospital for Sick Children, Toronto, Canada,Division of Gastroenterology and Hepatology, Saitama Children’s Medical Center, Japan
| | - Neil Warner
- SickKids Inflammatory Bowel Disease Centre, the Hospital for Sick Children, Toronto, Canada,Cell Biology Program, Research Institute, the Hospital for Sick Children, Toronto, Canada
| | - Daniel J Mulder
- SickKids Inflammatory Bowel Disease Centre, the Hospital for Sick Children, Toronto, Canada,Cell Biology Program, Research Institute, the Hospital for Sick Children, Toronto, Canada
| | - Daniel Kotlarz
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Dermot PB McGovern
- F. Widjaja Foundation Inflammatory Bowel Disease Center and Immunobiology Research Institute at Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Judy Cho
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, Hess Center for Science and Medicine, NY, USA
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Scott B Snapper
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Harvard Medical School; Division of Gastroenterology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Anne M Griffiths
- SickKids Inflammatory Bowel Disease Centre, the Hospital for Sick Children, Toronto, Canada,Department of Pediatrics, Institute of Medical Science and Biochemistry, University of Toronto, the Hospital for Sick Children, Toronto, Canada
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children’s Medical Center, Japan
| | - Aleixo M Muise
- SickKids Inflammatory Bowel Disease Centre, Hospital for Sick Children, Toronto, Canada; Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, Institute of Medical Science and Biochemistry, University of Toronto, Hospital for Sick Children, Toronto, Canada.
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20
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Ohmiya N, Oka S, Nakayama Y, Iwama I, Nakamura M, Shimizu H, Sumioka A, Abe N, Kudo T, Osawa S, Honma H, Okuhira T, Mtsufuji S, Imaeda H, Ota K, Matsuoka R, Hotta N, Inoue M, Nakaji K, Takamaru H, Ozeki K, Kobayashi T, Hosoe N, Tajiri H, Tanaka S. Safety and efficacy of the endoscopic delivery of capsule endoscopes in adult and pediatric patients: Multicenter Japanese study (AdvanCE-J study). Dig Endosc 2022; 34:543-552. [PMID: 34379849 DOI: 10.1111/den.14104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIM We retrospectively determined the safety and efficacy of the endoscopic delivery (ED) of capsule endoscopes. METHODS We enrolled 10,156 patients who underwent small bowel capsule endoscopy (SBCE), 3182 who underwent patency capsule (PC), and 1367 who underwent colon capsule endoscopy (CCE), at 11 gastroenterological and nine pediatric centers. RESULTS Small bowel capsule endoscopies, PCs, and CCEs were endoscopically delivered to 546 (5.4%), 214 (6.7%), and 14 (1.0%) patients, respectively. Only mild complications occurred for 21.6% (167/774), including uneventful mucosal damage, bleeding, and abdominal pain. Successful ED of SBCE to the duodenum or jejunum occurred in 91.8% and 90.7% of patients aged <16 years and ≥16 years, respectively (P = 0.6661), but the total enteroscopy rate was higher in the first group (91.7%) than in the second (76.2%, P < 0.0001), for whom impossible ingestion (87.3%) was significantly more common than prolonged lodging in the stomach (64.2%, P = 0.0010). Successful PC and CCE delivery to the duodenum occurred in 84.1% and 28.6%, thereafter the patency confirmation rate and total colonoscopy rate was 100% and 61.5%, respectively. The height, weight, and age cutoff points in predicting spontaneous ingestion were 132 cm, 24.8 kg, and 9 years 2 months, respectively, in patients aged <16 years. Patients aged ≥16 years could not swallow the SBCEs mainly due to dysphagia (75.0%); those who retained it in the esophagus due to cardiac disease (28.6%), etc. and in the stomach due to diabetes mellitus (15.7%), etc. CONCLUSIONS: This large-scale study supports the safety and efficacy of ED in adult and pediatric patients. UMIN000042020.
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Affiliation(s)
- Naoki Ohmiya
- Departments of Gastroenterology and Advanced Endoscopy, Fujita Health University School of Medicine, Aichi, Japan
| | - Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshiko Nakayama
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hirotaka Shimizu
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Akihiko Sumioka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Naoki Abe
- Division of Infectious Diseases and Immunology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoshi Osawa
- Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Hitoshi Honma
- Department of Gastroenterology and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Takeru Okuhira
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Shoji Mtsufuji
- Department of Gastroenterology, Kyoto Kujo Hospital, Kyoto, Japan
| | - Hiroyuki Imaeda
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
| | - Kazuhiro Ota
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Ryo Matsuoka
- Department of Pediatrics, Fuji City General Hospital, Shizuoka, Japan
| | - Naoki Hotta
- Department of Internal Medicine, Masuko Memorial Hospital, Aichi, Japan
| | - Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | | | | | - Keiji Ozeki
- Departments of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Taku Kobayashi
- Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
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21
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Hosokawa T, Tanami Y, Sato Y, Hara T, Iwama I, Ishimaru T, Kawashima H, Oguma E. Diagnostic Accuracy of Ultrasound for Detecting Gastric or Duodenal Ulcers in Pediatric Patients. J Ultrasound Med 2022; 41:457-469. [PMID: 33876858 DOI: 10.1002/jum.15727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/04/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Direct ultrasound imaging findings alone have low sensitivity for diagnosing duodenal (65%) and gastric ulcers (40%). This retrospective study evaluated the efficiency of ultrasound in detecting gastric/duodenal ulcers in pediatric patients through direct and indirect findings. METHODS We evaluated 244 children who underwent ultrasound and subsequent endoscopy within 4 weeks for direct and indirect imaging findings indicative of gastric/duodenal ulcers. Positive direct imaging findings revealed gastric or duodenal wall thickness >8 or 5 mm, respectively, and indirect findings revealed inflammatory changes, hyperechogenicity, and presence of lymph node around ulcers. Correspondingly, we calculated the sensitivity and specificity for diagnosing gastric/duodenal ulcers and used the Fisher's exact and Mann-Whitney U tests to compare the frequency of findings and gastroduodenal wall thicknesses in pediatric patients with gastric/duodenal ulcers. RESULTS Overall, 6 and 24 were diagnosed with gastric and duodenal ulcers, respectively. The sensitivities of direct and indirect findings were 60.0% (18/30) and 80.0% (24/30), respectively; the corresponding specificities were 98.1% (210/214) and 97.2% (208/214). The frequency of direct and indirect sonographic findings differed significantly between patients with gastric or duodenal ulcers (18/30 versus 24/30, P = .002). Gastric and duodenal wall thicknesses were greater in patients with gastric (6.6 ± 2.6 mm versus 3.6 ± 1.4 mm; P = .003) or duodenal ulcer (5.0 ± 1.4 mm versus 2.2 ± 1.0 mm; P <.0001), respectively, than in those without. CONCLUSIONS The frequency of indirect finding was greater than that of direct finding in pediatric patients with gastric/duodenal ulcers. Therefore, sonographers should carefully evaluate indirect findings around the stomach or duodenum.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Tomoko Hara
- Department of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Itaru Iwama
- Department of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Ishimaru
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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22
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Kumagai H, Shimizu T, Iwama I, Hagiwara SI, Kudo T, Takahashi M, Saito T, Kunisaki R, Uchino M, Hiraoka S, Naganuma M, Sugimoto K, Miyoshi J, Shibuya T, Hisamatsu T. A consensus statement on health-care transition for childhood-onset inflammatory bowel disease patients. Pediatr Int 2022; 64:e15241. [PMID: 35895501 DOI: 10.1111/ped.15241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/29/2022] [Accepted: 05/12/2022] [Indexed: 01/07/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic relapsing inflammatory disorder of the intestine. The incidence of IBD is increasing worldwide, including Japan, and in approximately 25% of all affected patients it is diagnosed before 18 years of age. For the health maintenance of such patients, planned transition to adult care systems is essential. Previous Japanese surveys have revealed gaps between adult and pediatric gastroenterologists with regard to their knowledge and perception of health-care transition for patients with childhood-onset IBD. In 2021-2022, several Web workshops to discuss issues related to the transitional care of IBD patients were held by the Ministry of Health, Labour and Welfare of Japan as part of their program for research on intractable diseases. Clinicians experienced in IBD treatment for pediatric and adult patients participated. As a result, this panel of adult and pediatric gastroenterologists developed five consensus statements on the issue of "transfer from pediatric to adult care" and nine statements on the issue of "addressing transitional care (transition program)." To address current gaps in health-care transition for childhood-onset IBD patients, a programmed approach to transition, and better partnerships between pediatric and adult gastroenterologists are indicated. It is hoped that this consensus statement will provide a basis for the development of appropriate guidelines for clinical practice.
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Affiliation(s)
- Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama City, Saitama, Japan
| | - Shin-Ichiro Hagiwara
- Department of Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Michiko Takahashi
- Department of Pediatrics, Sapporo Kosei General Hospital, Sapporo, Hokkaido, Japan
| | - Takeshi Saito
- Division of pediatric surgery, Chiba Children's Hospital, Chiba City, Chiba, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Motoi Uchino
- Division of Inflammatory Bowel Disease, Department of Gastroenterological Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Sakiko Hiraoka
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Third Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Ken Sugimoto
- First Department of Medicine, Hamamatsu University School Medicine, Hamamatsu, Shizuoka, Japan
| | - Jun Miyoshi
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Mitaka-shi, Tokyo, Japan
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Mitaka-shi, Tokyo, Japan
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23
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Kudo T, Jimbo K, Shimizu H, Iwama I, Ishige T, Mizuochi T, Arai K, Kumagai H, Uchida K, Abukawa D, Shimizu T. Qing-Dai for pediatric ulcerative colitis multicenter survey and systematic review. Pediatr Int 2022; 64:e15113. [PMID: 35831249 DOI: 10.1111/ped.15113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric ulcerative colitis (UC) is more challenging to treat than adult UC. Qing-Dai therapy is effective in adults but reports of its efficacy in children are unavailable. We conducted a questionnaire survey on Qing-Dai use among pediatric patients with UC in Japan to determine its efficacy and safety. METHODS Questionnaires were sent to 31 high-volume centers treating pediatric patients with inflammatory bowel disease. The number of patients using Qing-Dai, short-term and long-term effects, and adverse events were assessed. A systematic review of studies on the efficacy and safety of Qing-Dai usage for UC was also performed. RESULTS Overall, 29/31 facilities (93.5%) responded, Qing-Dai was used in 107 patients with UC, and 84/107 patients (78.5%) initiated treatment. Within 6 months, 81/101 (80.2%) patients had clinical remission, while 59/92 (64.1%) patients had no relapse and 29/92 (31.5%) experienced only one to two relapses yearly. Eighty-seven percent of the patients underwent regular follow ups for adverse events, among whom one patient was diagnosed with pulmonary arterial hypertension (PAH), five with enteritis, and one with headache. In the systematic review, the clinical remission rate was 50-80%, and PAH was observed in 14 of 1,158 patients (1.2%). CONCLUSIONS Qing-Dai is highly effective in treating pediatric UC. However, Qing-Dai should be administered with caution as it may cause adverse events such as PAH.
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Affiliation(s)
- Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Keisuke Jimbo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hirotaka Shimizu
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Keiichi Uchida
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Daiki Abukawa
- Department of General Pediatrics and Gastroenterology, Miyagi Children's Hospital, Miyagi, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
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24
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Miura M, Shimizu H, Saito D, Miyoshi J, Matsuura M, Kudo T, Hirayama D, Yoshida M, Arai K, Iwama I, Nakase H, Shimizu T, Hisamatsu T. Multicenter, cross-sectional, observational study on Epstein-Barr viral infection status and thiopurine use by age group in patients with inflammatory bowel disease in Japan (EBISU study). J Gastroenterol 2021; 56:1080-1091. [PMID: 34591171 DOI: 10.1007/s00535-021-01832-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/23/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Epstein-Barr virus (EBV) infection status in patients with inflammatory bowel disease (IBD), particularly those using thiopurines, may be associated with the risk of lymphoproliferative disorder and hemophagocytic lymphohistiocytosis. This was the first multicenter survey of EBV infection in Japanese patients with IBD. Factors related to the EBV infection status were also investigated. METHODS Five tertiary institutions in Japan participated in this study to examine pediatric and adult patients with IBD. Serum EBV anti-viral capsid antigen (VCA) IgG, EBV anti-VCA IgM, and anti-EBV nuclear antigen-antibody were measured in 495 patients with IBD. The patients' information was obtained from their medical records. Prior EBV infection was defined as anti-VCA IgM negativity and anti-VCA IgG positivity (UMIN000033004). RESULTS The patients' median age was 25 years (range 0-92 years). Of the 495 patients, nine were anti-VCA IgM-positive and 354 were anti-VCA IgG-positive (seroprevalence: 72.8%). The proportion of patients with prior EBV infection was 0% for those aged < 5 years, < 60% for those aged < 30 years, and > 90% for those aged > 30 years. The proportion of EBV-uninfected patients using thiopurines was 28.4% (52/183) for all patients and 51.8% (44/85) for pediatric patients. Age was significantly associated with anti-VCA IgG seropositivity (p < 0.01, odds ratio: 0.902, 95% confidence interval: 0.880-0.925). No cases of lymphoproliferative disorder, hemophagocytic lymphohistiocytosis, or chronic active EBV infection were reported. CONCLUSIONS Approximately 30% of Japanese patients with IBD were EBV-uninfected, including those using thiopurines. Age was a significant factor for anti-VCA IgG seropositivity.
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Affiliation(s)
- Miki Miura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Hirotaka Shimizu
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Daisuke Saito
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Jun Miyoshi
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Minoru Matsuura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Daisuke Hirayama
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masashi Yoshida
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan.
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Iwama I, Yoshida M, Hara T, Nambu R. Causes of Melena and Effective Examination Strategies in Children. Front Pediatr 2021; 9:780356. [PMID: 34956987 PMCID: PMC8692886 DOI: 10.3389/fped.2021.780356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Aim: Melena, or tarry black stool, is not a rare symptom encountered in pediatric clinical practice, and the bleeding source varies from the upper gastrointestinal tract to the small intestine. Endoscopy is effective in identifying bleeding, but it does not always identify the source of bleeding. Endoscopic examination in children is commonly challenging, and there are no detailed reports about the causes of melena in children. This observational study aimed to validate the cause of melena in children and to investigate more effective and less burdensome examination methods. Methods: We retrospectively reviewed the clinical records of 55 patients who underwent examination for melena. Results: In this research, 38 patients had underlying diseases such as malignancy and severe mental and physical disorders. The bleeding source was identified in 39 patients. The most common final diagnosis was duodenal ulcer (n = 22), and the other diagnoses were gastric ulcer, esophagitis, and esophageal varices. The upper gastrointestinal tract was the most common source of bleeding (n = 34). In five patients, the bleeding source was the small intestine. Vomiting, abnormal abdominal ultrasonography findings, and a hemoglobin level of ≤ 3 g/dL than the lower normal limit were significant factors indicating that the bleeding source can be found on esophagogastroduodenoscopy. Conclusions: The upper gastrointestinal tract was the most common bleeding source of melena in children. As in adults, esophagogastroduodenoscopy is the primary endoscopic method of choice. Furthermore, small bowel capsule endoscopy may be useful in identifying the bleeding source in children without upper gastrointestinal lesions.
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Affiliation(s)
- Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Masashi Yoshida
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Tomoko Hara
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
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Arai K, Kunisaki R, Kakuta F, Hagiwara SI, Murakoshi T, Yanagi T, Shimizu T, Kato S, Ishige T, Aomatsu T, Inoue M, Saito T, Iwama I, Kawashima H, Kumagai H, Tajiri H, Iwata N, Mochizuki T, Noguchi A, Kashiwabara T, Shimizu H, Suzuki Y, Hirano Y, Fujiwara T. Phenotypic characteristics of pediatric inflammatory bowel disease in Japan: results from a multicenter registry. Intest Res 2020; 18:412-420. [PMID: 32806870 PMCID: PMC7609396 DOI: 10.5217/ir.2019.00130] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/17/2020] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Setagaya, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Fumihiko Kakuta
- Department of General Pediatrics and Gastroenterology, Miyagi Children's Hospital, Sendai, Japan
| | - Shin-Ichiro Hagiwara
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Takatsugu Murakoshi
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
| | - Tadahiro Yanagi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Toshiaki Shimizu
- Department of Pediatric and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Japan
| | - Sawako Kato
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tomoki Aomatsu
- Department of Pediatrics, Osaka Medical College, Takatsuki, Japan
| | - Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takeshi Saito
- Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Itaru Iwama
- Department of Pediatrics, Okinawa Prefectural Chubu Hospital, Okinawa, Japan
| | | | - Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Hitoshi Tajiri
- Department of Pediatrics, Osaka General Medical Center, Osaka, Japan
| | - Naomi Iwata
- Division of Infectious Disease and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | | | - Atsuko Noguchi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Toshihiko Kashiwabara
- Department of Gastroenterology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Hirotaka Shimizu
- Division of Gastroenterology, National Center for Child Health and Development, Setagaya, Japan
| | - Yasuo Suzuki
- Inflammatory Bowel Disease Center, Toho University Sakura Medical Center, Sakura, Japan
| | - Yuri Hirano
- Division of Gastroenterology, National Center for Child Health and Development, Setagaya, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo, Japan
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Yodoshi T, Iwama I, Shinoura S. Pediatric endoscopy training in a community hospital in Japan. Pediatr Int 2020; 62:740-741. [PMID: 32424897 DOI: 10.1111/ped.14165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/15/2019] [Accepted: 01/17/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Toshifumi Yodoshi
- Department of Pediatrics, Okinawa Chubu Hospital, Okinawa, Japan.,Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Susumu Shinoura
- International University of Health and Welfare, Tokyo, Japan
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Iwama I, Shimizu H, Nambu R, Okuhira T, Kakuta F, Tachibana N, Abe N, Honma H, Kudo T, Nakayama Y. Efficacy and safety of a capsule endoscope delivery device in children. Eur J Gastroenterol Hepatol 2019; 31:1502-1507. [PMID: 31464784 DOI: 10.1097/meg.0000000000001513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This multicenter, cross-sectional study aimed to elucidate the efficacy and safety of the AdvanCE capsule endoscope delivery device for children in Japan. METHODS The present study analyzed 183 cases of small bowel capsule endoscope (SBCE) insertion performed using the AdvanCE in 154 patients aged less than 18 years at participating institutions between 2013 and 2017. Statistical analyses were conducted to identify factors contributing to the completion rate for the entire small intestine examination, small intestine transit time, adverse events and technical issues. RESULTS The commonest reason for using the AdvanCE was the patient's inability to swallow the SBCE, which was attributed to young age. SBCE was successfully delivered into the stomach or duodenum in 180 cases and was placed in the duodenum in 90% patients. In 89% patients, the entire small intestine was completely examined, and in 63% patients, findings leading to a new diagnosis or involving changing or maintaining the treatment strategy were obtained. No severe adverse events were observed; however, mild adverse events were observed in 35% patients. No factors considerably contributed to the completion rate for the entire small intestine examination or small intestine transit time and onset of technical issues. The factors that contributed to mild adverse events included intravenous anesthesia, technical issue, and absence of prior insertion of a patency capsule using the AdvanCE. CONCLUSION The AdvanCE is well tolerated and effective for children.
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Affiliation(s)
- Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama
| | - Hirotaka Shimizu
- Division of Gastroenterology, National Center for Child Health and Development
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama
| | - Takeru Okuhira
- Department of Pediatrics, Osaka Medical College, Takatsuki
| | - Fumihiko Kakuta
- Division of General Medicine and Gastroenterology, Miyagi Prefectural Children's Hospital, Sendai
| | - Nao Tachibana
- Division of Gastroenterology, Tokyo Metropolitan Children's Medical Center, Fuchu
| | - Naoki Abe
- Division of Infectious Diseases and Immunology, Aichi Child Health and Medical General Center, Obu
| | - Hitoshi Honma
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University, Tokyo
| | - Yoshiko Nakayama
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
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Abstract
Unilateral lung whiteout is not a common pediatric chest radiograph finding, but when it is encountered, timely and accurate interpretations of the radiograph are required because life-threatening respiratory failure can be associated. Lung whiteout may result from several conditions, and the differential diagnosis has a broad range. We describe 4 pediatric patients with different etiologies of unilateral lung whiteout: a large pleural effusion, mainstem bronchial plugging with a large cast, a mediastinal tumor, and consolidation. The ultimate causal diagnosis may not be initially obvious, but valuable clues can usually be found in the conventional chest radiograph to assist with appropriate early management. Chest ultrasound provides additional information, and we recommend it as the second examination for such patients.
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Affiliation(s)
- Itaru Iwama
- From the Department of Pediatrics, Okinawa Chubu Hospital, Okinawa, Japan
| | - Moriyasu Kohama
- From the Department of Pediatrics, Okinawa Chubu Hospital, Okinawa, Japan
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Eda K, Mizuochi T, Iwama I, Inui A, Etani Y, Araki M, Hara S, Kumagai H, Hagiwara SI, Murayama K, Murakami J, Shimizu N, Kodama H, Yasuda R, Takaki Y, Yamashita Y. Zinc monotherapy for young children with presymptomatic Wilson disease: A multicenter study in Japan. J Gastroenterol Hepatol 2018; 33:264-269. [PMID: 28452067 DOI: 10.1111/jgh.13812] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/16/2017] [Accepted: 04/24/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Few studies of zinc monotherapy for presymptomatic Wilson disease have focused on young children. We therefore evaluated long-term efficacy and safety of zinc monotherapy for such children and established benchmarks for maintenance therapy. METHODS We retrospectively and prospectively examined children under 10 years old with presymptomatic Wilson disease who received zinc monotherapy from time of diagnosis at 12 participating pediatric centers in Japan. RESULTS Twenty-four patients met entry criteria. Aspartate aminotransferase and alanine aminotransferase decreased significantly beginning 1 month after initiation of treatment and usually remained under 50 U/L from 1 to 8 years of treatment. Twenty four-hour urinary copper decreased significantly at 6 months and usually remained under 75 μg/day and between 1 and 3 μg/kg/day for the remainder of the study. All patients continued to take zinc, and none became symptomatic. In patients under 6 years old who received 50 mg/day of zinc as an initial dose, aspartate aminotransferase and alanine aminotransferase significantly decreased at 1 month after initiation of treatment, as did γ-glutamyltransferase and 24-h urinary copper at 6 months. CONCLUSIONS To our knowledge, this is the first multicenter study of zinc monotherapy for young children with presymptomatic Wilson disease. Such monotherapy proved highly effective and safe. Maintaining normal transaminase values (or values under 50 U/L when normalization is difficult) and 24-h urinary copper excretion between 1 and 3 μg/kg/day and under 75 μg/day is a reasonable goal. An initial dose of 50 mg/day is appropriate for patients under 6 years old.
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Affiliation(s)
- Keisuke Eda
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Itaru Iwama
- Department of Pediatrics, Okinawa Chubu Hospital, Uruma, Japan
| | - Ayano Inui
- Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Yuri Etani
- Department of Pediatric Gastroenterology, Nutrition, and Endocrinology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Mariko Araki
- Department of Pediatrics, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Shinya Hara
- Department of Pediatrics, Toyota Memorial Hospital, Toyota, Japan
| | - Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Shin-Ichiro Hagiwara
- Division of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Jun Murakami
- Division of Pediatrics and Perinatology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Norikazu Shimizu
- Department of Pediatrics, Toho University School of Medicine, Ohashi Medical Center, Tokyo, Japan
| | - Hiroko Kodama
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryosuke Yasuda
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Yugo Takaki
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Yushiro Yamashita
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
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31
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Abstract
Ingestion of foreign bodies in children is a commonly occurring event worldwide. Swallowed foreign bodies usually pass successfully through the alimentary canal, from the mouth to the anus, but occasionally they may become lodged in the lumen of the oesophagus and cause complications. Accurate diagnosis of a retained foreign body is crucial in anticipating and preventing complications, but diagnostic delay can occur. We present a case of delayed diagnosis of a foreign body ingestion in an infant. Based on our experience, we emphasise the importance of accurate interpretation of X-rays with particular attention paid to the region of highest suspicion by the first touch physician.
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Affiliation(s)
- Itaru Iwama
- Department of Pediatrics, Okinawa Chubu Hospital, Uruma city, Okinawa, Japan
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Iwama I, Chinen K, Kato S, Kikuchi K. A pediatric case of pancreaticobiliary maljunction demonstrated by endoscopic ultrasonography. Journal of Pediatric Surgery Case Reports 2013. [DOI: 10.1016/j.epsc.2013.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Affiliation(s)
- Itaru Iwama
- Division of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan.
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