Publications by authors named "Tsunaki Sawada"
A 75-year-old male, hospitalized with back pain, remained hospitalized for tests for unexplained colitis, which was diagnosed as inflammatory bowel disease unclassified and treated with antibiotics and prednisolone, resulting in Clostridioides difficile colitis. Therefore, antibiotics were discontinued, and oral metronidazole treatment was initiated; however, as the patient's fever persisted, blood cultures were performed. An anaerobic bottle of blood culture turned positive the following day.
View Article and Find Full Text PDFBackground And Aims: We sought to validate the British Society of Gastroenterology (BSG) guidelines for acute lower gastrointestinal bleeding (ALGIB).
Methods: We analyzed 8,956 patients with ALGIB in CODE BLUE-J study and categorized them into four groups based on BSG guidelines. Outcomes included 30-day rebleeding, 30-day mortality, blood transfusion, therapeutic intervention, and severe bleeding.
Introduction: The PillCam™ patency capsule is useful in preventing capsule endoscope retention; however, visual confirmation of patency capsule excretion is challenging for many patients.
Objective: We investigated the factors related to the patency capsule remaining in the colon after 33 h and the factors hindering the visual confirmation of its excretion.
Methods: We retrospectively analyzed 498 patients with intestinal patency who underwent patency capsule examination.
Vedolizumab is a treatment option for ulcerative colitis but data on predictors of treatment response remain insufficient to establish personalized treatment strategies. We aimed to investigate the real-world effectiveness of vedolizumab in adult patients with ulcerative colitis and explore factors involved in predicting treatment response. This single-center, single-arm, prospective observational study included 26 patients with clinically active ulcerative colitis patients' characteristics at baseline, epidemiological information, existing treatment, clinical activity index score, endoscopic score, and blood test data were collected.
View Article and Find Full Text PDFIntroduction: Recently, the detection of superficial non-ampullary duodenal epithelial tumors (SNADETs) including adenomas and superficial duodenal carcinomas has increased. Various endoscopic treatment methods have also been reported for SNADETs, but there are few reports on the natural history. The aim of this study was to analyze factors related to tumor growth and determine the characteristics of SNADETs which need early therapeutic intervention.
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- Inflammation in ulcerative colitis (UC) begins in the colorectal mucosa, and studying the intestinal mucus could reveal valuable biomarkers for this condition.
- Researchers used colonoscopy to collect mucus and mucosal samples, allowing them to analyze RNA and protein levels of neuropeptides in both active and remission areas of UC.
- They found that somatostatin (SST) levels were higher in remission areas of the mucus, suggesting its role as a key indicator of UC activity and potential therapeutic target.
Enterovesical fistula (EVF) in Crohn's disease (CD) often does not improve with medical treatment and requires surgical treatment. The surgical treatment strategy for EVF in CD is definitive resection of the intestinal tract side, and performing a leak test using dye injection into the bladder after EVF dissection to determine the appropriate surgical procedure for the bladder side. This study aimed to evaluate the outcomes of surgical treatment for EVF in CD.
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- The study examined the link between blood group O and the likelihood of rebleeding in patients with acute lower gastrointestinal bleeding (ALGIB).
- Out of 2336 patients analyzed, those with blood group O had higher rebleeding rates within 30 days (17.9%) and 1 year (21.9%) compared to non-O patients.
- Blood group O was found to be an independent risk factor for rebleeding, while rates of thrombosis and mortality were similar between groups.
Article Synopsis
- Crohn's disease (CD) leads to ongoing inflammation in the gastrointestinal tract, with small bowel capsule endoscopy (SBCE) being crucial for monitoring patency and treatment progress, especially in the small bowel.
- This study analyzed 120 out of 166 patients who underwent SBCE, focusing on the timing of clinical changes, stricture-free rates, and treatment strategies after the procedure.
- Results showed a significant portion of patients needed treatment changes over time, with the GI patency rate dropping after 2 years, suggesting patients without treatment changes should undergo SBCE every 2 years for effective monitoring.
Background: Numerous biological interventions and small molecules are used to treat Crohn's disease; however, the effectiveness of these treatments varies largely. Non-responsiveness to biological therapies is associated with interleukin (IL)-18 gene polymorphisms and high IL-18 expression has been implicated in the pathogenesis of Crohn's disease.
Aims: The aim of this study was to elucidate the expression of precursor and mature IL-18 in patients with Crohn's disease who exhibited varied responses to cytokine-targeted treatments and determine whether selective inhibition of mature IL-18 offers a novel therapeutic avenue.
Article Synopsis
- Endoscopic healing (EH) in ulcerative colitis (UC) is a target for treatment, but many patients experience relapses even after achieving it.
- A study assessed how recent systemic steroid use affects relapse risk in UC patients with confirmed EH, including 1212 patients over two years.
- Results showed a significant increase in relapse rates for those who used steroids within the last year (28.8%) compared to those who haven’t used steroids recently (5.6%), indicating that time since steroid use is crucial for assessing relapse risk.
Article Synopsis
- The study analyzed 8,254 cases of patients with acute lower gastrointestinal bleeding to find key factors that predict mortality and create a reliable prediction tool.
- Researchers established the CACHEXIA score, which uses factors present at admission and management during hospitalization to assess the risk of death within 30 days and 1 year.
- The CACHEXIA score demonstrated high accuracy (ROC-AUC 0.93 for 30 days; C-index 0.88 for 1 year) with significant differentiation of mortality risk, indicating that patients with high scores need continuous monitoring after discharge.
Article Synopsis
- - The study analyzed data from 2699 patients with acute lower gastrointestinal bleeding (ALGIB) to assess the effectiveness of endoscopic treatments based on bleeding location, type, and cause of recent hemorrhage stigmata. - Results showed that rebleeding rates varied significantly by location (15.5% in the left colon vs. 28.6% in the right) and bleeding cause (27.5% for diverticular bleeding vs. 8.9% for other causes), with endoscopic treatment generally reducing overall rebleeding rates. - The findings suggest a tailored endoscopic treatment strategy depending on bleeding location and type, indicating ligation is more effective than clipping for right-colon diverticular bleeding, highlighting the complexity of risks associated
Background: Antitumor necrosis factor (TNF)-α antibodies have improved the outcome of inflammatory bowel disease (IBD); but half of patients remain unresponsive to treatment. Interleukin-18 (IL-18) gene polymorphism is associated with resistance to anti-TNF-α antibodies, but therapies targeting IL-18 have not been clinically applied. Only the mature protein is biologically active, and we aimed to investigate whether specific inhibition of mature IL-18 using a monoclonal antibody (mAb) against a neoepitope of caspase-cleaved mature IL-18 could be an innovative treatment for IBD.
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- A study analyzed data from 10,342 patients with acute lower gastrointestinal bleeding (ALGIB) to better understand surgical rates, procedures, and outcomes.
- Surgery was performed in only 1.3% of patients, with common indications being diverticular bleeding, colorectal cancer, and small bowel bleeding, and the overall mortality rate was 1.5% for those who underwent surgery.
- The findings suggest that identifying the source of bleeding and using endoscopic techniques may lower the need for surgery and enhance treatment for ALGIB.
Article Synopsis
- * The study involved 31 patients treated with UST, with clinical remission rates improving from 9.7% at 2 weeks to 64.5% at 48 weeks; however, 38.7% of patients discontinued treatment, primarily due to primary failure.
- * High baseline C-reactive protein (CRP) levels were identified as a significant risk factor for discontinuation of UST, highlighting the need for clinicians to consider CRP when making treatment decisions for UC patients.
Article Synopsis
- This study compared the effects of early versus delayed feeding in patients with acute lower gastrointestinal bleeding (ALGIB) after their bleeding was controlled.
- Researchers analyzed data from 5,910 patients across Japan, dividing them into early (feeding within 1 day) and delayed (feeding after 2-3 days) groups.
- Results showed no significant differences in rebleeding rates or need for further treatments between the groups, but the early feeding group had a shorter hospital stay, suggesting it is a safe and beneficial practice.
Article Synopsis
- A study analyzed the impact of weekend admissions on outcomes for patients with acute lower gastrointestinal bleeding in 49 Japanese hospitals from 2010 to 2019.
- The findings showed no significant difference in mortality rates between weekend and weekday admissions, although weekend admissions resulted in a higher need for blood transfusions.
- Additionally, weekend admissions led to delays in early colonoscopy and an increase in urgent CT scans, but overall mortality and other outcomes remained unaffected.
Article Synopsis
- Obscure gastrointestinal bleeding can occur when the source of bleeding is unknown, even after procedures like balloon-assisted endoscopy; Dieulafoy's lesion in the small bowel is often suspected as the cause.
- A retrospective study analyzed 38 patients diagnosed with Dieulafoy's lesion through double-balloon endoscopy, focusing on their clinical characteristics and whether bleeding could be predicted before the procedure.
- The median age of patients was 72, with a high comorbidity rate; most lesions were found in the upper jejunum and lower ileum, with a 21% rebleeding rate after endoscopic treatment, and multiple episodes of hematochezia linked to the likelihood of receiving multiple diagnoses.
Article Synopsis
- A predictive model called the LONG-HOSP score was developed to assess the risk of prolonged hospital stays for patients admitted with acute lower gastrointestinal bleeding (ALGIB), based on their baseline characteristics.
- The study analyzed data from over 8,500 patients across 49 hospitals to create and validate this model, which includes factors such as age, body mass index, and various lab results.
- Findings revealed that certain conditions and treatments during hospitalization, like colitis diagnosis and early colonoscopy, significantly impacted the length of stay, with early interventions helping to reduce it.
Article Synopsis
- This study compares the effectiveness of short vs. long attachment caps in colonoscopy for identifying causes of acute hematochezia, specifically looking at recent hemorrhage.
- Using data from over 6,400 patients, researchers found that long cap users had significantly higher rates of diagnosing colonic diverticular bleeding and identifying active bleeding, compared to short cap users.
- The conclusion suggests that long cap-assisted colonoscopy is more effective for diagnosing acute hematochezia and recognizing bleeding compared to short caps.
Background: Rebleeding after hemostasis of the gastroduodenal ulcer (GDU) is one of the indicators associated with death among GDU patients. However, there are few studies on risk score that contribute to rebleeding after endoscopic hemostasis of bleeding peptic ulcers.
Aims: The aim of this study was to identify factors associated with rebleeding, including patient factors, after endoscopic hemostasis of bleeding gastroduodenal ulcers and to stratify the risk of rebleeding.
Article Synopsis
- A study analyzed long-term outcomes of 5048 patients hospitalized for acute lower gastrointestinal bleeding (ALGIB) in Japan to understand risks of recurrence after discharge.
- Findings revealed that 25.8% of patients experienced rebleeding within an average follow-up of 31 months, with significant mortality risks increasing for those with out-of-hospital rebleeding episodes.
- Key risk factors for rebleeding included shock index, blood transfusion, in-hospital rebleeding, colonic diverticular bleeding, and thienopyridine use, while endoscopic hemostasis was found to reduce rebleeding risk.
Article Synopsis
- - The study compared the effectiveness of two ligation therapies, endoscopic detachable snare ligation (EDSL) and endoscopic band ligation (EBL), in treating colonic diverticular bleeding (CDB) using data from 518 patients within a multicenter study.
- - Findings revealed no significant differences in outcomes like initial hemostasis, recurrent bleeding within 30 days, mortality, or need for additional interventions between the two treatment groups.
- - Sigmoid colon involvement and a history of acute lower gastrointestinal bleeding (ALGIB) were identified as significant risk factors for long-term recurrent bleeding, emphasizing the need for careful follow-up after ligation therapy.
Article Synopsis
- - The study aimed to create a predictive model for detecting stigmata of recent hemorrhage (SRH) in patients with acute lower gastrointestinal bleeding (LGIB) to prioritize colonoscopy treatment.
- - Researchers analyzed data from 8,360 patients treated in Japan, focusing on various characteristics and factors to develop and validate the CS-NEED score for predicting SRH presence.
- - The CS-NEED score demonstrated strong predictive accuracy, helping to identify which patients were likely to benefit from endoscopic therapy, with higher scores correlating with increased SRH detection rates.