Trends in gastroesophageal reflux disease in Japanese children and adolescents

BACKGROUND

Although the prevalence of gastroesophageal reflux disease (GERD) has been increasing in Japan, little is known about the prevalence and severity of GERD in pediatric patients. This study compared the prevalence and severity of endoscopically proven GERD in pediatric patients seen at an endoscopy center in Japan over a 15-year period.

METHODS

This was a retrospective chart review of Japanese children aged 5-18 years undergoing esophagogastroduodenoscopy for upper gastrointestinal symptoms or anemia between 2005 and 2019. The prevalence and severity of reflux esophagitis and endoscopic Barrett's esophagus were compared between the periods 2005-2012 and 2013-2019.

RESULTS

A total of 564 patients were evaluated: 315 from 2005 to 2012 (mean ± SD) age 13.8 ± 3.0 (range, 5-18 years; 147 boys; and 249 from 2013 to 2019 (mean ± SD) 14.7 ± 2.8 (range, 5-18) years; 108 boys. Demographics and clinical features were similar between the two groups. The proportion with erosive esophagitis or endoscopic Barrett's esophagus increased significantly between the two periods (9.8% to 18.1% for GERD, P = 0.0045 and 2.5% to 9.6% for Barrett's esophagus, P = 0.0003). The proportion of GERD patients with endoscopic Barrett's esophagus also significantly increased between the two periods (24/45 [53.3%]) vs (8/31 [25.8%]), P = 0.017].

CONCLUSION

The prevalence and severity of endoscopically proven GERDs has significantly increased over the past 15 years at an endoscopy center in Japan. Detailed population-based studies are needed to assess whether this is occurring throughout Japan.

Clinical features of Helicobacter pylori antibody-positive junior high school students in Nagano Prefecture, Japan

BACKGROUND

Previously, we conducted an epidemiological study screening for Helicobacter pylori antibody positivity among Japanese junior high school students. In this study, we updated the epidemiological data and assessed the clinical features of H pylori antibody-positive junior high school students.

MATERIALS AND METHODS

We assessed H pylori antibody-positive subjects who were identified between 2012 and 2015 at four junior high schools in Nagano Prefecture, Japan. H pylori infection was confirmed by urea breath test (UBT) or endoscopic examination. Endoscopy was performed after obtaining consent from the subject and their guardians. Eradication therapy consisted of triple therapy with proton pump inhibitor (PPI), amoxicillin (AMPC), and clarithromycin (CAM) or metronidazole (MNZ) for seven days. Eradication of H pylori was confirmed by UBT. We reviewed subjects' characteristics, endoscopic findings, histological findings, eradication regimes, outcomes, and adverse effects.

RESULTS

The overall prevalence of H pylori antibody positivity was 3.2% (42/1298). We assessed thirteen H pylori antibody-positive subjects. Eight subjects had a family history of H pylori infection. Six subjects had abdominal pain, and two subjects had iron deficiency anemia (IDA). Twelve subjects underwent endoscopy; one subject had duodenal ulcer, eleven subjects had antral nodular gastritis, and six subjects showed grade 2 closed type atrophic border according to the Kimura-Takemoto classification. All subjects received eradication therapy; CAM was used in five subjects with CAM susceptibility as well as in three subjects with unknown information on CAM susceptibility, and MNZ was used in five subjects with CAM resistance. Eradication was successful in twelve subjects (one unconfirmed). There were three mild adverse effects (abdominal pain or diarrhea).

CONCLUSIONS

Helicobacter pylori test for junior high school students represents an opportunity to diagnose the peptic ulcer, iron deficiency anemia, and gastric atrophy.

Presepsin as a predictor of positive blood culture in suspected neonatal sepsis

BACKGROUND

Although the incidence of neonatal sepsis is decreasing, neonatal sepsis remains a severe life-threatening disease. No current biochemical marker can provide perfect diagnostic accuracy for neonatal sepsis. The aim of this study was therefore to evaluate the accuracy of presepsin (P-SEP) as a novel biomarker of bacterial infection for neonatal sepsis diagnosis.

METHODS

We prospectively studied newborns with sepsis (sepsis group; n = 13) during the first 30 days after birth and compared them with control preterm newborns (control group; n = 18). In addition, we evaluated term newborns with some clinical signs of early onset sepsis (non-sepsis term group; n = 35).

RESULTS

P-SEP in the sepsis group was significantly higher than in the control group (P < 0.001) The area under the curve for P-SEP was 0.868 (95%CI: 0.71-1.00). A P-SEP cut-off of 795 pg/mL was established, with 85% sensitivity and 89% specificity. The positive and negative predictive values were 85% and 89%, respectively. In the non-sepsis term group, P-SEP had better stability than white blood cells and C-reactive protein for 3 days after birth.

CONCLUSIONS

P-SEP can better discriminate between infections and non-infectious inflammatory conditions than the currently used biomarkers.

Human intestinal spirochetosis in Japanese patients aged less than 20 years: Histological analysis of colorectal biopsy and surgical specimens obtained from 479 patients

Human intestinal spirochetosis (HIS) is a condition in which spirochetes attach to and colonize the colorectal epithelium. To our knowledge, no comprehensive studies of HIS in young patient have been published in a developed country. This study aimed to determine the incidence and clinicopathological manifestations of HIS in Japanese patients aged less than 20 years. We retrospectively reviewed 3605 biopsy and 92 surgical specimens obtained from 479 patients admitted to Shinshu University Hospital between 1997 and 2014. All slides were reviewed independently by two pathologists to confirm the histological presence of spirochetes. Among 387 patients who underwent biopsy, the most common pathologic diagnosis was ulcerative colitis (12.6%, n = 49). Additionally, about half of the biopsy specimens showed non-specific, mildly inflamed mucosa (50.6%, n = 196); only one of these cases was HIS. On the other hand, among the surgical specimens, we found no cases of HIS. We concluded that the incidence of HIS in Japanese young patients was 0.2% (1/479 cases). The incidence of HIS in Japanese young patients was very low, and one HIS case was associated with colitis with abdominal pain.

Impact of Decreased Serum Insulin-Like Growth Factor-1 Levels on Central Aortic Compliance in Small-for-Gestational-Age Infants

BACKGROUND

Intrauterine growth restriction is associated with arterial hypertension in adulthood; however, the underlying mechanism is unclear.

OBJECTIVES

We hypothesized that serum insulin-like growth factor-1 (IGF-1) levels affect central aortic elastic properties and structure in small-for-gestational-age (SGA) infants.

METHODS

Eighteen SGA infants and 22 appropriate-for-gestational-age (AGA) infants were enrolled in this study. The serum IGF-1 level within 1 h of birth and abdominal aortic echo parameters at 1 week of age were retrospectively compared.

RESULTS

In the SGA infants, IGF-1 levels (27.6 ± 17.7 vs. 42.6 ± 15 ng/ml, p = 0.006), aortic strain (10.2 ± 3.1 vs. 12.8 ± 3.1%, p = 0.01), and aortic distensibility (0.73 ± 0.19 vs. 0.92 ± 0.34 cm2/dyn × 10-4, p = 0.05) were significantly lower compared with AGA infants. By contrast, blood pressure, aortic intima-media thickness (aIMT) in relation to body weight (383 ± 163 vs. 256 ± 43 μm/kg, p < 0.001), aortic stiffness index in relation to body weight (2.0 ± 1.7 vs. 1.1 ± 0.4, p = 0.005), and arterial pressure-strain elastic modulus (293 ± 72 vs. 242 ± 78 mm Hg, p = 0.04) were higher compared with AGA infants. In the SGA infants, IGF-1 levels were significantly correlated with aortic strain (r = 0.49, p = 0.04), aIMT in relation to body weight (r = -0.61, p = 0.007), and aortic stiffness index in relation to body weight (r = -0.63, p = 0.005).

CONCLUSIONS

Decreased serum IGF-1 levels in SGA infants may affect the vascular compliance and structure of the central aorta.

Cardiovascular Remodeling and Dysfunction Across a Range of Growth Restriction Severity in Small for Gestational Age Infants - Implications for Fetal Programming

BACKGROUND

The purpose of this study was to clarify cardiovascular structure and function in small for gestational age (SGA) infants across a range of intrauterine growth restriction (IUGR) severity.

METHODS AND RESULTS

This prospective study included 38 SGA infants and 30 appropriate for gestational age (AGA) infants. SGA infants were subclassified into severe and mild SGA according to the degree of IUGR. Cardiovascular structure and function were evaluated using echocardiography at 1 week of age. Compared with the AGA infants, both the severe and mild SGA infants showed increased left ventricular diastolic dimensions (severe SGA 10.2±2.4, mild SGA 8.2±1.3, and AGA 7.3±0.7 mm/kg, P<0.05 for all) and decreased global longitudinal strain (severe -21.1±1.6, mild -22.5±1.8, and AGA -23.8±1.8%, P<0.05 for all). Severe SGA infants showed a decreased mitral annular early diastolic velocity (severe 5.6±1.4 vs. AGA 7.0±1.3 cm/s, P<0.01) and increased isovolumic relaxation time (severe 51.3±9.2 vs. AGA 42.7±8.2 ms, P<0.01). Weight-adjusted aortic intima-media thickness and arterial wall stiffness were significantly greater in both SGA infant groups. These cardiovascular parameters tended to deteriorate with increasing IUGR severity.

CONCLUSIONS

SGA infants, including those with mild SGA, showed cardiovascular remodeling and dysfunction, which increased with IUGR severity. (Circ J 2016; 80: 2212-2220).

Ampicillin- and ampicillin/sulbactam-resistant Escherichia coli infection in a neonatal intensive care unit in Japan

The incidence of ampicillin (ABPC)-resistant Escherichia coli (E. coli) infection in very low-birthweight infants has been increasing. The rate of ABPC/sulbactam (ABPC/SBT)-resistant E. coli in this population, however, is currently unknown. We encountered two cases of severe infection due to resistant E. coli and retrospectively studied the prevalence of ABPC- and ABPC/SBT-resistant E. coli in regular surveillance cultures obtained from all neonatal intensive care unit (NICU) patients between 2000 and 2013. The overall prevalence of ABPC-resistant E. coli was 39% (47/120), accounting for 63% of cases (32/51) between 2007 and 2013, compared with 22% (15/69) between 2000 and 2006. The prevalence of ABPC/SBT resistance was 17% (20/120), which was similar in both periods (16%, 8/51 vs 17%, 12/69). According to these results, not only ABPC, but also ABPC/SBT-resistant E. coli must be considered in the NICU.

Endocrinological meaning of hyperandrogenism in patients with polycystic ovary

In the light of excessive ovarian androgen hormone production in cases of polycystic ovarian disease (PCO), we have made an endocrinological, symptomatological and morphological study of PCO in women with high serum testosterone levels. The following results were obtained: (1) High serum testosterone levels were found in 18.1% of the infertile women. (2) Morphologically, 44.4% of these women had PCO (the PCO group), and 55.6% did not have PCO (non-PCO group). (3) No significant differences between these groups were found in mean testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrone (E1), 17 beta-estradiol (E2) levels, or the E1/E2 ratio, but the LH/FSH ratio was significantly higher in the PCO group. (4) The incidence of menstrual irregularities and hirsutism were significantly higher in the PCO group, but the incidence of obesity did not differ between the groups. (5) No correlation between testosterone and LH or E1 levels was found in the PCO group, but strong positive correlations were found in the non-PCO group. From the above findings it is suggested that in women with high peripheral blood testosterone levels, the presence of morphological abnormalities on the ovaries has effects on gonadotropin production and therefore on the incidence of menstrual irregularities and hirsutism.

Prognostic potential of serum CA 125 levels in danazol-treated patients with external endometriosis: a preliminary study

Serum levels of CA 125 in 33 patients with progressive external endometriosis who were treated with 400 mg/day of Danazol for 16 weeks were assayed for an extended period (24-40 weeks), and changes in the CA 125 pattern were analyzed. Patterns of hormonal response were classified into four types. Prognosis for one type was good, whereas that for the other three types was poor. By making use of these patterns, we were able to determine more accurately the proper dose of Danazol, to alter the duration of treatment, and to predict relapse.

Prenatal diagnosis of valvar aortic stenosis by Doppler echocardiography and magnetic resonance imaging

We present herein a case of valvar aortic stenosis diagnosed antenatally, using color and pulsed Doppler echocardiography and magnetic resonance imaging. The benefit and advantages of the use of magnetic resonance imaging, complementary to the Doppler echocardiography, are discussed.

The survivability of the ectoparasitic flagellate Ichthyobodo necator on chum salmon fry (Oncorhynchus keta) in seawater and comparison to Ichthyobodo sp. on Japanese flounder (Paralichthys olivaceus)

Experimental studies revealed that a freshwater ectoparasitic flagellate Ichthyobodo necator (Henneguy, 1883) could survive and reproduce in seawater after infected chum salmon fry, Oncorhynchus keta (Walbaum), were transferred directly from fresh water to 33% seawater. Minor morphological changes (slight reduction in body width, loss of twistlike wrinkles on body surface, and reduction in contractile vacuoles) were observed in the attached form of I. necator following transfer to seawater. The field survey also confirmed that I. necator occurs on chum salmon fry in seawater estuaries (salinity 17-34%) and in freshwater habitats. It was assumed that I. necator acquired salinity tolerance as a result of adapting to the migratory behavior of its anadromous host. Two morphologically similar bodonids, I. necator from chum salmon and Ichthyobodo sp. from marine Japanese flounder, Paralichthys olivaceus (Temminck and Schlegel), were differentiated by cross-infection experiments. Thus, the parasite from marine flounder should be regarded as a separate species from I. necator.

Relationship between the delayed-reaction type of LH-RH test and obesity in sterile women with ovulatory disturbances: a preliminary report

We investigated 312 sterile women to look for a possible relationship between obesity and infertility. The LH-RH test was performed on 113 of these women. The obesity index was determined according to the Japanese variation of Broca's index. The results were as follows: (1) Among 312 sterile women, 8.7% were obese and one-fifth of anovulatory patients showed a tendency toward obesity. (2) The pregnancy rate was lower in obese women. (3) The delayed-reaction type in the LH-RH test was observed in 29.2% of total patients; the rate in patients with anovulation (20.4%) was lower than that in those with ovulation (37.3%). (4) The rate of the delayed-reaction type in anovulatory obese patients was 100%. This evidence shows that obesity was related to anovulation and/or infertility, as determined by the delayed-reaction type in the LH-RH test.

Clinical application of the swim-up and washing of human spermatozoa

Artificial insemination with husband's semen is one of the treatments in cases of male infertility. A technique for swim-up and washing sperm is described. A special device was used for introduction of sperm into the uterus. Sperm density after treatment by swim-up and washing of sperm was lower than in the pretreatment specimens, but sperm motility, motile sperm count, and conception rate after treatment were higher.

CA-125 is an effective marker for patients with external endometriosis and on danazol: case reports

Serum levels of CA-125 in women with external endometriosis and on danazol were assayed for an extended period, and changes in the CA-125 pattern were analyzed. Whereas the prognosis for the patients in case 1 was good, those for cases 2, 3, and 4 were poor. We propose that the Ca-125 levels should be carefully determined for individual patients, because a relapse can be predicted.

Clinical usefulness of determination of CA 125 levels in the serum and menstrual blood

We measured CA 125 levels in sera and menstrual blood of subjects with a normal ovulatory cycle and in those with endometriosis. Serum CA 125 levels were higher in the latter, in each phase of the menstrual cycle. The CA 125 levels in patients with endometriosis, particularly those with adenomyosis, tend to be higher than in those with a normal ovulatory cycle. We propose that measurement of CA 125 in the menstrual blood may be able to help distinguishing adenomyosis from myoma uteri and may also help in assessing clinical endometriosis.