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.

The relationship between environmental conditions and water balance during training for baseball and American football was analyzed. The environmental conditions were assessed in terms of WBGT (wet-bulb globe temperature) based on NDB (natural dry-bulb temperature), NWB (natural wet-bulb temperature) and GT (globe temperature), as WBGT=0.7NWB+0.2GT+0.1NDB,
During baseball training, a commercially available sports drink was provided ad libitum, whereas during American football training, the effect of free water intake was compared between tap-water and sports drink. The sweat rate and the amount of water consumption were significantly correlated with WBGT under each experimental condition. Body weight loss was 0.2% body wt./h during baseball training, whereas during American football training, body weight loss was 0.5%/h with tap-water and 0.4%/h with sports drink on average, revealing a significantly higher value for tap-water.
These results indicate that both sweat loss and water intake during exercise increase with WBGT, and that body weight loss is maintained at a fairly constant level during exercise with free water intake, although the loss is significantly higher when tap-water is provided.

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.

The relationship between environmental conditions and water balance during training for baseball and American football was analyzed. The environmental conditions were assessed in terms of WBGT (wet-bulb globe temperature) based on NDB (natural dry-bulb temperature), NWB (natural wet-bulb temperature) and GT (globe temperature), as WBGT=0.7NWB+0.2GT+0.1NDB,
During baseball training, a commercially available sports drink was provided ad libitum, whereas during American football training, the effect of free water intake was compared between tap-water and sports drink. The sweat rate and the amount of water consumption were significantly correlated with WBGT under each experimental condition. Body weight loss was 0.2% body wt./h during baseball training, whereas during American football training, body weight loss was 0.5%/h with tap-water and 0.4%/h with sports drink on average, revealing a significantly higher value for tap-water.
These results indicate that both sweat loss and water intake during exercise increase with WBGT, and that body weight loss is maintained at a fairly constant level during exercise with free water intake, although the loss is significantly higher when tap-water is provided.

Objective: The development of hepatocellular carcinoma (HCC) is not uncommon in patients who achieve eradication of the hepatitis C virus through direct-acting antiviral (DAA) treatment. The aim of this study was to identify the patients at high risk for novel HCC development after a sustained virologic response (SVR) by DAA treatment.Patients and Methods: A total of 518 patients with no history of HCC treatment and who achieved SVR by DAA treatment were evaluated retrospectively. The correlations between HCC development and the patients’ characteristics were evaluated. For patients who underwent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) or dynamic contrast-enhanced computed tomography, the relationship between the imaging findings and subsequent HCC development was also assessed.Results: HCC developed newly in 22 patients, and the 1-year and 3-year cumulative HCC rates were 2.0% and 8.5%, respectively. In multivariate analysis, a FIB-4 index >4.0 and a post-treatment α-fetoprotein >4.0 ng/ml were significant risk factors for HCC. In 26 of 118 patients who underwent an MRI before DAA treatment, a non-hypervascular hypo-intense nodule was seen in the hepatobiliary phase, and in 6 of 182 patients who underwent a CT, a non-hypervascular hypo-enhanced nodule was seen in the delayed phase. The sensitivity and specificity of the MRI-positive findings for the subsequent development of HCC were 0.92 and 0.87, respectively, and those of the CT were 0.40 and 0.99, respectively. In multivariate analysis of patients who underwent an MRI, a non-hypervascular hypo-intense nodule was the only factor that was significantly related to HCC development (HR 32.4, p = 0.001).Conclusion: Gd-EOB-DTPA-enhanced MRI was found to be reliable for risk evaluation of subsequent HCC development in patients after SVR by DAA treatment. Patients with a non-hypervascular hypo-intense nodule need more careful observation for incident HCC.

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.