著者

Kazuhiro Ota Ryosuke Yamaguchi Akihiro Tsukahara Shinya Nishida Taro Shigekiyo Satoshi Harada Yuichi Kojima Toshihisa Takeuchi Shigeki Arawaka Kazuhide Higuchi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.4684-20, (Released:2020-05-23)

参考文献数

12

被引用文献数

9

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A 68-year-old woman presented with a 2-year history of worsening unsteady gait. Her neurological examination revealed peripheral neuropathy with lower limb sensory dominance. T2-weighted imaging revealed a disorder of the posterior cervical cord. Blood test findings revealed vitamin B12 deficiency, and gastroscopy revealed typical findings of autoimmune gastritis. She received vitamin B12 supplementation, but some peripheral neuropathy symptoms persisted due to longstanding vitamin B12 deficiency. Asymptomatic patients should undergo gastroscopy to detect autoimmune gastritis, as chronic vitamin B12 deficiency causes irreversible peripheral neuropathy.

著者

Kazuhiro Ota Toshihisa Takeuchi Kouki Kodama Haruhiko Ozaki Satoshi Harada Yuichi Kojima Sadaharu Nouda Masahiro Goto Kazuhide Higuchi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.3, pp.343-344, 2018-02-01 (Released:2018-02-01)

参考文献数

7

被引用文献数

1 3

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Although S-1 chemotherapy is used widely as postoperative adjuvant chemotherapy for gastric cancer, some patients experience diarrhea during treatment. The patient was a 39-year-old woman who underwent distal gastrectomy for gastric cancer and who had started S-1 chemotherapy as postoperative adjuvant chemotherapy 1 week before her presentation. She experienced severe diarrhea immediately after starting the course of S-1 tablets. Capsule endoscopy revealed severe S-1-induced enteritis with extensive mucosal injury in the ileum and red intestinal fluid due to the oozing of blood in the ileum. After reducing the dosage of S-1, her diarrhea became milder, and she was able to continue S-1 chemotherapy.

著者

Kazuhide Higuchi Takashi Joh Koji Nakada Ken Haruma

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.52, no.13, pp.1447-1454, 2013 (Released:2013-07-01)

参考文献数

23

被引用文献数

5 14

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Objective Proton pump inhibitors (PPIs) are widely used as the mainstay of treatment for erosive reflux esophagitis, based on the excellent results obtained in clinical trials. However, the endoscopic remission rates in patients treated with PPIs in actual clinical settings have not been fully assessed. We conducted a nationwide survey to evaluate the effectiveness of PPIs based on endoscopic findings in real-world clinical settings. Methods This was a multicenter retrospective study conducted among 41 Japanese institutions. Endoscopic findings before and after PPI therapy were collected from the medical records of patients diagnosed with Los Angeles grade A-D reflux esophagitis who had been treated with a PPI for at least eight weeks before undergoing a second endoscopy. The remission rates of erosive esophagitis, defined as the percentage of patients with grade N or M findings following PPI therapy, were calculated. Results Data for 541 patients were analyzed. At first endoscopy, 45.5%, 30.3%, 15.9% and 8.3% of patients were diagnosed with grade A, B, C and D esophagitis, respectively. The mean duration of PPI therapy was 410 days, and the mean remission rate was 61.6%. The remission rate was significantly lower in the patients with more severe erosive esophagitis based on the LA grade before PPI therapy. Conclusion This study revealed that approximately 40% of the patients did not achieve remission of erosive esophagitis following PPI therapy for a mean of 1.1 years. This suggests the necessity of providing careful follow-up using periodic endoscopy and appropriately selecting PPI therapy.