Background/Aims: Diarrhea-predominant irritable bowel syndrome (IBS-D)-like symptoms frequently occur in patients with quiescent Crohn’s disease (CD). To investigate the factors underlying IBS-D-like symptoms in patients with quiescent CD, we performed a comprehensive analysis of the clinical features and intestinal environment in those patients. Methods: We performed a prospective observational study of 27 patients with quiescent CD (CD activity index [CDAI] ≤ 150; C-reactive protein ≤ 0.3 mg/dL). The presence and severity of IBS-D-like symptoms, health-related quality of life, disease-specific quality of life, andstatus of depression and anxiety were evaluated. The level of intestinal permeability, fecal calprotectin and organic acids and the profiles of gut microbiome were analyzed. Results: Twelve of the 27 patients with quiescent CD (44.4%) had IBS-like symptoms, and these patients showed a significantly higher CDAI, IBS severity index and anxiety score than those without. The inflammatory bowel disease questionnaire score was significantly lower in the patients with IBS-D-like symptoms. There were no significant differences in small intestinal/colonic permeability or the levels of organic acids between the patients with and without IBS-D-like symptoms. Fusicatenibacter was significantly less abundant in the patients with IBS-D-like symptoms whereas their fecal calprotectin level was significantly higher (384.8 ± 310.6 mg/kg) than in patients without (161.0 ± 251.0 mg/kg). The receiver operating characteristic curve constructed to predict IBS-D-like symptoms in patients with quiescent CD using the fecal calprotectin level (cutoff, 125 mg/kg) showed a sensitivity and specificity of 73.3% and 91.7%, respectively. Conclusion Minimal inflammation is closely associated with the development of IBS-D-like symptoms in patients with quiescent CD.

Pelvic floor trauma developing into pelvic frailty is a significant concern in urogynecology or orthopedics. The majority of women who have experienced vaginal childbirth are affected, to a certain extent, by some form of pelvic floor damage, thereby eliciting substantial alterations of functional anatomy in the pelvic cavity which are manifested as urinary incontinence or pelvic organ prolapse (e.g., uterine prolapse). With the above in mind, medical researchers, continence experts, and continence exercise practitioners in the research areas of sports medicine and rehabilitation medicine believe that the coordinated activity of pelvic floor muscles, in association with the abdominal muscles, is a prerequisite for urinary and defecatory continence. Since the pelvic floor forms the base of the abdominal cavity, stronger pelvic floor muscles are crucial in maintaining such capabilities. Opposing action of the abdominal and pelvic floor muscles ensures that exercises for one may also strengthen the other. Appropriate abdominal maneuverability or logical exercise training of the abdominal muscles may thus be beneficial in maintaining not only strength but also coordination, flexibility, and endurance of pelvic floor muscles and abdominal muscles. Such exercises, collectively known as pelvic floor muscle training, may be effective for long-term pelvic cavity care and also in rehabilitating cases of pelvic floor dysfunction. Further research is needed, however, in determining whether pelvic floor muscle function can be truly enhanced or maintained by such exercises in cases of pelvic floor dysfunction and/or decreased urinary continence.

Esophageal achalasia is a primary motility disorder characterized by insufficient lower esophageal sphincter relaxation and loss of esophageal peristalsis. Achalasia is a chronic disease that causes progressive irreversible loss of esophageal motor function. The recent development of high-resolution manometry has facilitated the diagnosis of achalasia, and determining the achalasia subtypes based on high-resolution manometry can be important when deciding on treatment methods. Peroral endoscopic myotomy is less invasive than surgery with comparable efficacy. The present guidelines (the “2019 Seoul Consensus on Esophageal Achalasia Guidelines”) were developed based on evidence-based medicine; the Asian Neurogastroenterology and Motility Association and Korean Society of Neurogastroenterology and Motility served as the operating and development committees, respectively. The development of the guidelines began in June 2018, and a draft consensus based on the Delphi process was achieved in April 2019. The guidelines consist of 18 recommendations: 2 pertaining to the definition and epidemiology of achalasia, 6 pertaining to diagnoses, and 10 pertaining to treatments. The endoscopic treatment section is based on the latest evidence from meta-analyses. Clinicians (including gastroenterologists, upper gastrointestinal tract surgeons, general physicians, nurses, and other hospital workers) and patients could use these guidelines to make an informed decision on the management of achalasia.

PURPOSE: Due to adverse events, dose reduction or withdrawal of adjuvant chemotherapy is required for some patients. To identify the predictive factors for tolerability to postoperative adjuvant S-1 monotherapy in gastric cancer (GC) patients, we evaluated the predictive values of blood indicators. MATERIALS AND METHODS: We analyzed 98 patients with pStage II/III GC who underwent postoperative adjuvant S-1 monotherapy. We retrospectively analyzed correlations between 14 parameters obtained from perioperative routine blood tests to assess their influence on the withdrawal of postoperative adjuvant S-1 monotherapy, within 6 months after discontinuation. RESULTS: Postoperative adjuvant chemotherapy was discontinued in 21 patients (21.4%) within 6 months. Univariable analysis revealed that high preoperative albumin-bilirubin (ALBI) scores had the highest odds ratio (OR) for predicting the failure of adjuvant S-1 chemotherapy (OR, 6.47; 95% confidence interval [CI], 2.08–20.1; cutoff value, –2.696). The high ALBI group had a significantly shorter time to failure of postoperative adjuvant S-1monotherapy (hazard ratio, 3.48; 95% CI, 1.69–7.25; P=0.001). Multivariable analysis identified high preoperative ALBI score as an independent prognostic factor for tolerability (OR, 10.3; 95% CI, 2.33–45.8; P=0.002). CONCLUSIONS: Preoperative ALBI shows promise as an indicator associated with the tolerability of adjuvant S-1 monotherapy in patients with pStage II/III GC.
Chemotherapy, Adjuvant ; Drug Therapy ; Gastrectomy ; Hematologic Tests ; Humans ; Odds Ratio ; Retrospective Studies ; Stomach Neoplasms

BACKGROUND/AIMS: Few studies are available that have investigated the risk factors for overlapping irritable bowel syndrome (IBS)-like symptoms in patients with inactive inflammatory bowel disease (IBD). The present study has 3 objectives: (1) to assess the prevalence of IBS-like symptoms in Japanese patients with inactive IBD using Rome III criteria, (2) to examine the relationship of IBS-like symptoms to health related quality of life (HR-QOL), and (3) to investigate associations for developing IBS-like symptoms in patients with inactive IBD. METHODS: IBS-like symptoms were evaluated using the Rome III questionnaire for functional gastrointestinal disorders. HR-QOL and hospital anxiety and depression scale were evaluated. RESULTS: IBS-like symptoms were found in 17.5% (7/40) of patients with inactive ulcerative colitis, 27.1% (29/107) of patients with inactive Crohn’s disease (CD), and 5.3% (23/438) of healthy control subjects. The QOL level was significantly lower and anxiety score was significantly higher in inactive CD patients with IBS-like symptoms than in those without such symptoms (P = 0.003, P = 0.009). Use of anti-anxiety drugs was associated with the presence of IBS symptoms (P = 0.045). HR-QOL score was lower and anxiety score was higher in patients with inactive ulcerative colitis, but the difference was not statistically significant. CONCLUSIONS: The prevalence of IBS-like symptoms in inactive IBD patients was significantly higher than in healthy controls. Inactive CD patients with IBS-like symptoms has low QOL and anxiety; suggesting that anxiety may be associated with symptom development in such patients.
Anti-Anxiety Agents ; Anxiety ; Asian Continental Ancestry Group* ; Colitis, Ulcerative ; Depression ; Gastrointestinal Diseases ; Humans ; Inflammatory Bowel Diseases* ; Irritable Bowel Syndrome ; Prevalence* ; Quality of Life ; Risk Factors

Recently, the palliative care team (PCT) at our hospital has included dentists. Among a total of 127 cancer patientsand required PCT intervention from 2009 to 2014, 17 patients (13.3%) had oral symptoms. Therefore, the PCT held discussions in order to determine the optimal way to treat each patient. Various symptoms, including oral pain, dry mouth, taste disturbance, furred tongue, excessive amounts of saliva, appetite loss, and trismus were treated by the dentists. As a result, the oral findings improved in all patients, while the oral symptoms improved in 16 of the 17 patients (94%). Thanks to the fact that dentists have joined the PCT, oral symptoms are effectively relieved, and PCT members now have an increased interest in oral cavity complications. Furthermore, conducting thorough examinations of the oral cavity by the PCT not only results in an improved QOL, but it has also increased the interest in the oral cavity on the part of the PCT. Therefore, more effective palliative care is expected to be achieved by promoting increased cooperation with more clinical departments.

  The purpose of this study was to clarify the effects of ingesting chloridquellen and bicarbonate spring waters on electrogastrography and heart rate variability in humans. The subjects were ten young adults (average age 21.9 years old). Three and six cycles per minute (cpm) frequency of electrogastrography (EGG) were measured, as well as the high-frequency (HF: 0.15-0.40Hz) components, and the ratio of low-frequency (LF: 0.04-0.15Hz) components to HF components in heart rate variability (HRV) during 90 minutes. The taste of the water and pain or abnormalities in the stomach were also assessed by having the subjects answer a questionnaire. The subjects ingested the spa water or purified water and were asked to respond to the questionnaire after thirty minutes, and they also ingested no water on a different day and were questioned. The EGG-6 cpm frequency, presumably reflecting intestinal activity, did not change under any conditions. The EGG-3 cpm frequency, presumably reflecting stomach activity, significantly increased with bicarbonate spring waters immediately after ingestion and decreased after 30 min. Additionally, the 3 cpm frequency significantly increased with ingestion of purified water over the course of 30 min. The HF components in HRV, presumably reflecting cardiac parasympathetic activity, did not change under any conditions. The ratio of LF to HF components in HRV, presumably reflecting cardiac sympathetic activity, significantly increased with ingestion of purified water immediately and after 15 min, and bicarbonate spring waters after 30 min. There was a difference between ingestion of chloridquellen and purified water in the answers concerning the taste of the water in the questionnaire. These findings suggest that the constituent parts of chloridquellen water and other factors activate stomach and autonomic nervous activities in humans.

  We previously reported that in patients with Alzheimer’s disease (AD), the number of baths that patients report taking at their first evaluation at a memory clinic was significantly decreased in comparison to before the onset of dementia. Based on this research, we thought further longitudinal evaluation was needed regarding the relationship between the number of baths, cognitive impairment and depression state after AD progression. In the present study, we reevaluate the number of baths; cognitive function tests (Hasegawa’s Dementia Scale-Revised [HDS-R], Mini Mental State Examination [MMSE] and Wechsler Adult Intelligence Scale-Revised [WAIS-R]); and the depression assessment (Zung Self-rating Depression Scale [SDS]) 1 year after first evaluation.   At the first evaluation, the average number of baths taken by 65 AD patients (16 male, 49 female; range: 64-90 years, average: 79.5±5.6 years), was 5.6±1.6 bathsweek. At the reevaluation, this number had decreased to 4.9±1.9 bathsweek. In the WAIS-R, a significant positive correlation was found between the score change in number of baths and the change in performance intelligence quotient (PIQ) and total intelligence quotient (TIQ). However, no significant correlation was found between the score change in number of baths and the change in HDS-R, MMSE, or verbal intelligence quotient in WAIS-R or SDS.   We further evaluated the present series by dividing the study population into two subtypes: a group of patients in which the number of baths decreased 1 year after the first evaluation, and a group in which there was no change. There were no significant differences in background factors (e.g. average age at first evaluation) between the groups. Although, no significant difference was observed between the groups in number of baths before dementia onset (both were 6.7 timesweek), a significant difference was found at the first evaluation (5.3 bathsweek vs 5.9 bathsweek, respectively). No significant differences were observed between the groups in cognitive function test or depression assessment at the first evaluation. However, on reevaluation the group with the decreased number of baths showed significantly lower PIQ and TIQ scores in WAIS-R and a significantly higher SDS score.   The results of the present study suggested that number of baths decreased along with the progression of AD and the greatest participating factor was the practical dysfunction reflected by the PIQ score in WAIS-R. Furthermore, we considered the existence of two subtypes: patients in whom the number of baths decreases with AD progression and those in whom there is no change.

  In Japan, the Hot Springs Law and the Guideline of Analytical Methods of Mineral Springs (revised) classify springs containing 74 Bq/kg of radon as “hot springs” and those with radon levels exceeding 111 Bq/kg as “medical springs” called “radioactive spring”. Radon is a noble gas that easily diffuses in air.   This study evaluates exposure dose due to radon when using a radioactive spring at a spa in the Toriido area, Komono town, Mie district, Mie prefecture.   After bath water was supplied through a pipe from hot spring storage tanks to bathtubs, only 5.3-18.0% of radon remained in the water. Two days later, only 0.3-0.4% of the radon remained in the bath water due to radioactive decay and diffusion into air being increased by bathing and recirculation filtering.   The calculated effective dose from bathing in radioactive hot spring was 2.8-12.0 nSv, and that from drinking radioactive hot spring water was 5.1-23.3 nSv. To determine the total effective dose from use of the hot spring facility that may effects on human health, it is necessary to analyze radon concentrations not only in the water but also the surrounding air.