Acute hepatitis C often progresses to chronic infection. We undertook a randomized controlled trial to determine whether short-term therapy with interferon (IFN) during acute hepatitis C is effective in preventing the development of chronic hepatitis. Thirty patients with acute hepatitis C were randomized into 1 of 2 treatment groups. IFN therapy was initiated 8 weeks after the onset of acute hepatitis in the early-intervention group and after 1 year of observation in the late-intervention group. Short-term therapy consisted of natural IFN-alfa (6 million units) administered on consecutive days for a period of 4 weeks. Any signs of recrudescence of disease were immediately followed by interval IFN therapy (3 times weekly for 20 weeks). In the early-intervention group, short-term therapy was associated with a sustained virological response in 13 of 15 patients (87%). Follow-up treatment was associated with a sustained virological response in both of the remaining 2 patients (100%). The sustained virological response rate was significantly higher in the early-intervention group (87%, 13 of 15 patients after short-term therapy alone, and 100%, 15 of 15 patients after short-term with or without follow-up therapy) than in the late-intervention group (40%, 6 of 15 patients after short-term therapy alone, and 53%, 8 of 15 patients after short-term therapy with or without follow-up therapy, P ‫؍‬ .021 and P ‫؍‬ .006, respectively). A cute hepatitis that develops after infection with the hepatitis C virus (HCV) is often followed by chronic hepatitis, which may progress eventually to cirrhosis and hepatocellular carcinoma (HCC). 1,2 In the past, the primary causes of infection with HCV were blood transfusion and various medical procedures. Today, blood products in Japan are aggressively screened for HCV and disposable medical devices are in widespread use; there has been a reduction in the incidence of HCV infection. However, patients with acute hepatitis C resulting from treatment-related accidents (needle-stick injury), intravenous drug abuse, sexual contact with HCVpositive partners and unknown causes still occasionally present. [3][4][5] Interferon (IFN) therapy in patients with chronic hepatitis C has considerable potential for preventing the development of HCC, either by eradicating HCV, or by decreasing the activity of hepatitis. 6 -9 However, the therapeutic effects of IFN vary depending on the HCV genotype and viral load. 10,11 Although much research has already been undertaken on IFN therapy for acute hepatitis C, findings in trials that relate to the effectiveness of this therapy have not been particularly favorable. Possible reasons include differences in types of IFN, differences in study populations, and inclusion of patients with posttransfusion hepatitis. 12-17 However, Jaeckel et al. 3 reported that a 24-week course of IFN therapy was effective, and that the response to IFN treatment was more favorable in acute hepatitis C than in chronic hepatitis C. Although randomized controlled trials have been used t...

No abstract

EBD using DBE is a useful and safe procedure for small intestinal short strictures in CD patients. We conclude that this procedure is a therapeutic option that should be attempted before resorting to surgical therapy.

No abstract

Background The short-and long-term results of balloon dilation therapy in Crohn's patients with non-anastomotic obstructive gastrointestinal lesions are investigated.Materials and methods Fifty-five patients with Crohn's disease who had obstructive gastrointestinal lesions were treated prospectively by endoscopic balloon dilation.Short-term results Eight of the initial dilations were unsuccessful giving no symptomatic relief (14.5%).Long-term results The subjects of the long-term prognosis were 40 cases followed up for more than 6 months (average 37 months) and their strictures were non-anastomotic in more than half (59%). Avoidance of surgery, was possible in 31 of 40 patients (78%). Surgery was avoided in 92%, 81% and 77% of patients after one, two, and three years, respectively (Kaplan-Meier's method). There was no difference in long-term outcome between anastomotic strictures and strictures in the absence of prior surgery.Conclusion Our results suggest that, (1) strictures in the absence of prior surgery might be treated in this way as well as anastomotic strictures; (2) if followed for a prolonged time period, more than 70% of patients, who have undergone balloon dilation for obstructive gastrointestinal Crohn's disease, may be able to avoid surgery. of these underwent balloon dilation in our institute.All the procedures were performed by study members (T.M., S.T., K.Y. and S.S.) in a uniform procedure.Patients Thirty-two of the 55 patients were male. Age at the onset of gastrointestinal symptoms was ranged from 15 to 36 years (average 26.6). The diagnosis of Crohn's disease was confirmed endoscopically, radiographically or histologically. Before obstructive symptoms occurred, their disease had been followed for an average of 7.9 years (range 0.8-10.0). They were classified into 14 small intestinal (6 gastroduodenal), 34 ileocolitis, and 7 colitis type cases. At the time of dilation 32 (58%) had previously undergone surgery. Six patients had gastroduodenal stenoses and 49 patients had ileocolic stenoses. At the time of dilation 45 patients had mild to severe obstructive symptoms and 10 did not have obvious obstructive symptoms but had severe strictures which an endoscope was not able to pass through. These 10 patients had been recieving nutritional therapy (total parenteral nutrition or elemental diet) for active diseases for several weeks and were on nil by mouth. After disease activity had settled down to remission stage (CDAI < 150), colonoscopic evaluation revealed severe stenosis in these patients. They did not have obstructive symptoms because they had not ingest an ordinary diet yet. Seven of the ten asymptomatic patients turned out to be symptomatic during follow-up when on a regular diet. Indications for DilationIndications for balloon dilation were as follows:(1) patients who had strictures in gastroduodenal lesions or ileocolonic lesions, (2) the activity of the disease was quiescent (CDAI < 150, in 48) or not highly active (150 < CDAI < 250, in 7), (3) their general condition was not extremely p...

The addition of ED for Crohn's disease patients who responded to initial anti-TNF induction therapy was not found to improve outcomes. The efficacy of concomitant ED in other clinical settings, such as loss of response, needs to be clarified in the future (UMIN000009789).

The patient, an 81-year-old woman, was admitted to our hospital for a detailed examination; the chief complaint being melena. An upper gastrointestinal roentgenologic study revealed a submucosal tumor with a smooth surface and a stalk measuring 50 mm at the third part of the duodenum. Endoscopy depicted it as a yellowish submucosal tumor. Based on computed tomography and fluoroscopy of the small intestine, a diagnosis of duodenal lipoma was made. The esophagus, stomach, and the small and large intestines were free of lesions so the duodenal lipoma was judged to be the hemorrhagic source. The tumor was endoscopically polypectomized using a 2-channel scope. The excised specimen, measuring 50 x 20 x 20 mm, was covered by a normal duodenal mucosa with small ulcers in part. Photomicrographic findings included a tumor that was composed of mature adipose tissue in the submucosa, which coincided with a diagnosis of lipoma. Small ulcers had formed in part, exposing vessels, thus indicating the cause for hemorrhage. Lipoma is a benign tumor; and if the lesion is found to be pedunculated and an endoscope can reach it for treatment, minimally invasive endoscopic procedures should be selected.

Background: Intestinal mucosal lesions in Crohn's disease were endoscopically evaluated before and after giving infliximab, and the usefulness of this treatment was investigated. Patients and methods: The present study included 12 patients with active Crohn's disease who could undergo colonoscopy before and after giving infliximab. (i) The treatment assessment consisted of evaluations of short-term and long-term therapeutic effects. The clinical evaluation was conducted using the Crohn's disease activity index (CDAI). The results of the clinical evaluation were compared with those of the colonoscopic evaluation. (ii) The endoscopic evaluation findings were divided into polyposis, ulcer and stenosis, and the area ranging from the rectum to the terminal ileum. The scores for the findings at seven sites were totaled. In the short-term therapeutic effect, characteristics of ulcer morphology and background factors were investigated endoscopically. Results: (i) The efficacy rate was 92% clinically and 67% endoscopically in the evaluation of short-term therapeutic effects. The efficacy rate was 86% clinically and 86% endoscopically in the evaluation of long-term therapeutic effects. (ii) On the endoscopic evaluation, the ulcer score was significantly (P = 0.03) improved after giving infliximab, while there was no remarkable change in the polyposis score and the stenosis score tended to worsen. On the evaluation of therapeutic effects based on ulcer morphology, infliximab was endoscopically effective in patients with longitudinal ulcers. On the evaluation of therapeutic effects based on background factors, the treatment was effective in patients given a combination of infliximab and immunosuppressants. Conclusion: The ulcerative lesions were found to be markedly improved, but the intestinal stenosis tended to worsen, after giving infliximab. It is necessary that the severity of intestinal stenosis be adequately understood before giving infliximab. Giving immunosuppressants should be used for combined treatment.