Collagenous colitis (CC) has been looked upon as a rare disease in the past years. However, as we have acquired more knowledge about this disease, the cases diagnosed as CC are on the rise. Many case reports on Lansoprazole (LPZ) are available in our country, and our hospital has had three cases in the last year. Here, we present a typical example. Case 1: An 84-year-old woman who had been taking LPZ visited our outpatient clinic, complaining of chronic watery diarrhea for three months. Colonoscopy produced no abnormal findings other than a tiny capillary vascular growth in the descending colon. However, the histopathological findings secured from the entire colonic region revealed a thickened subepithelial collagen band. She was therefore diagnosed as suffering from CC. With the administration of LPZ suspended, her diarrhea improved in two weeks. The other two cases also underwent colonoscopy to check their chronic diarrhea. Their symptoms improved in a few weeks with the intake of LPZ suspended. In the differential diagnosis of chronic diarrhea, therefore, we believe it important to take possible CC into account, review the detailed history of medicine, and perform colonoscopy and mucosal biopsy.

A 74-year-old man with diabetes underwent colonoscopy as routine screening for coloncancer. An Anisakis larva was found incidentally during colonoscopy usingthe retroflexion technique in the ascending colon, and was removed using a forceps.Asymptomatic colonic anisakiasis is very rare, and few reports have described diagnosisand treatment of anisakiasis during colonoscopy by the retroflexion technique in theascending colon. We have reported this rare case along with a literature review.

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic method and treatment approach for biliary diseases. However, biliary cannulation can be difficult in some cases. We performed ERCP in a 97-year-old woman with abdominal pain resulting from acute cholangitis caused by choledocholithiasis and observed difficult biliary cannulation. Eventually, the patient was successfully treated with the rendezvous technique. We could not cannulate the biliary duct during ERCP twice. Therefore, we placed a percutaneous transhepatic gallbladder drainage (PTGBD) tube without intrahepatic dilation. The rendezvous technique was performed using the PTGBD tube. The patient did not experience pancreatitis or perforation.

Introduction：Hyponatremia, which is frequently present in patients with end-stage cancer, causes delirium and disturbance of consciousness and is considered a poor prognostic factor. We report a case of hyponatremia with hypopituitarism in association with leptomeningeal metastasis, resulting in reversible disturbance of consciousness. Case report：A 77 year-old female received chemotherapy at our hospital for postoperative recurrence of lung cancer, and best supportive care due to a side effect. After transfer to another hospital, she experienced a sudden disturbance of consciousness and was returned to our hospital. A detailed examination resulted in a diagnosis of hyponatremia from hypopituitarism following leptomeningeal metastasis involving the cerebral ventricles. Hyponatremia was improved by NaCl supplement and hormone replacement, followed by recovery from disturbance of consciousness. Discussion：QOL of patients with end-stage cancer can be improved through the active treatment of reversible causes of disturbance of consciousness. Conclusion：When severe hyponatremia is detected in cancer patients, it is important to consider the possibility of hypopituitarism with brain metastasis or meninges dissemination in the differential diagnosis.

Objective: Combination therapy with glecaprevir and pibrentasvir (G/P) has been shown to provide a sustained virologic response (SVR) rate of >97% in patients with chronic hepatitis C virus (HCV) infection in the first published real-world Japanese data. However, a recently published study showed that the treatment was often discontinued in patients ≥75 years old, resulting in low SVR in intention-to-treat (ITT) analysis. Thus, our aim was to evaluate real-world data for G/P therapy in patients ≥75 years of age, the population density of which is high in “rural” regions.Patients and Methods: We conducted a multicenter study to assess the efficacy and safety of G/P therapy for chronic HCV infection, in the North Kanto area in Japan.Results: Of the 308 patients enrolled, 294 (95.5%) completed the treatment according to the protocol. In ITT and per-protocol analyses, the overall SVR12 rate was 97.1% and 99.7%, respectively. The old-aged patients group consisted of 59 participants, 56 of whom (94.9%) completed the scheduled protocol. Although old-aged patients tended to have non-SVR factors such as liver cirrhosis, history of HCC, and prior DAA therapies, the SVR12 rates in old-aged patients were 98.3% and 100% in the ITT and PP analyses, respectively. Of 308 patients enrolled, adverse events were observed in 74 patients (24.0%), with grade ≥3 events in 8 patients (2.6%). There was no significant difference in any grade and grade ≥3 adverse events between the old-aged group and the rest of the study participants. Only one patient discontinued the treatment because of adverse events.Conclusion: G/P therapy is effective and safe for old-aged patients.