Background/Aims: Multiple white and flat elevated lesions (MWFL) that develop from the gastric corpus to the fornix may be strongly associated with oral antacid intake. Therefore, this study aimed to determine the association between the occurrence of MWFL and oral proton pump inhibitor (PPI) intake and clarify the endoscopic and clinicopathological characteristics of MWFL. Methods: The study included 163 patients. The history of oral drug intake was collected, and serum gastrin levels and anti-Helicobacter pylori immunoglobulin G antibody titers were measured. Upper gastrointestinal endoscopy was performed. The primary study endpoint was the association between MWFL and oral PPI intake. Results: In the univariate analyses, MWFL were observed in 35 (49.3%) of 71 patients who received oral PPIs and 10 (10.9%) of 92 patients who did not receive oral PPIs. The occurrence of MWFL was significantly higher among patients who received PPIs than in those who did not (p<0.001). Moreover, the occurrence of MWFL was significantly higher in patients with hypergastrinemia (p=0.005). In the multivariate analyses, oral PPI intake was the only significant independent factor associated with the presence of MWFL (p=0.001; odds ratio, 5.78; 95% confidence interval, 2.06–16.2). Conclusions Our findings suggest that oral PPI intake is associated with the presence of MWFL (UMINCTR 000030144).

Objective:To confirm the effect of fluid with different viscosity on the normal biomechanical sequence of oropharyngeal swallowing in healthy males.Methods:Fifteen healthy male subjects [(27.7±1.8) years old] were recruited from November 2011 to February 2012 and instructed to swallow 15 ml of water (W), nectar-like fluid (N), and honey-like fluid (H) in an upright sitting position. The sensing system was consisted of tongue pressure sensor sheet, bend sensor, surface electrodes and microphone. They were used to monitor tongue pressure, hyoid activity, surface electromyography (EMG) of swallowing-related muscles and swallowing sound, respectively. The swallowing sound was chosen as the reference time. The significance of biomechanical sequence of structural events was determined by repeated-measures analysis of variance (ANOVA).Results:When swallowing liquid of any consistency, hyoid premotor and suprahyoid muscle electromyography (EMG) appeared synchronously ( P>0.05), followed by the simultaneous appearances of hyoid rapid movement, peak time of suprahyoid muscle EMG, onset of infrahyoid muscle EMG, and anterior tongue pressure production ( P>0.05). The peak time of infrahyoid muscle EMG was very close to the peak time of anterior tongue pressure ( P>0.05), and both of them were earlier than the time that the hyoid reaching the highest position ( P<0.05). At last, the time that the hyoid departing the highest position was synchronized with the disappearances of suprahyoid muscle EMG, infrahyoid muscle EMG, and tongue pressure ( P>0.05). The tongue pressure production and peak time of tongue pressure arose from anterior to posterior along the midline of hard palate during normal swallowing, with the significances for tongue pressure production between the anterior site and the middle site (W: P=0.035, N: P=0.027, H: P=0.013) as well as the anterior site and the posterior site (W: P<0.001, N: P<0.001, H: P<0.001), while the appearance and peak time of the circumferential tongue pressure were very close ( P>0.05). The increase of fluid viscosity did not affect the biomechanical sequence of the above structural physiological movements during normal swallowing. There were statistically significant differences between the hyoid premotor and the onset of suprahyoid muscle EMG when swallowing the honey-like liquid [(-1.03±0.47) and (-0.90±0.50) s] and water[(-0.87±0.32) and (-0.74±0.31) s] ( P<0.001). Among the delayed structural events, except for the onset of infrahyoid muscle EMG and the tongue pressure production on the anterior site ( P>0.05), the occurrences of all the parameters in swallowing honey-like fluid were significantly later than those in swallowing water (onset of hyoid rapid movement, P=0.007; time of hyoid reaching the highest position, P=0.034; time of hyoid departing the highest position, P=0.041; offset of hyoid movement, P=0.035; peak time of suprahyoid muscle EMG: P=0.040; offset of suprahyoid muscle EMG, P=0.014; peak time of infrahyoid muscle EMG: P=0.042; offset of infrahyoid muscle EMG, P=0.028; peak time of Ch.1: P=0.045; offset of Ch.1: P=0.012; onset of Ch.2: P=0.038; peak time of Ch.2: P=0.009; offset of Ch.2: P=0.034; onset of Ch.3: P=0.043; peak time of Ch.3: P=0.011; offset of Ch.3: P=0.026;onset of Ch.4: P=0.040; peak time of Ch.4: P=0.038; offset of Ch.4: P=0.033; onset of Ch.5: P=0.046; peak time of Ch.5: P=0.028; offset of Ch.5: P<0.001), but not for those between nectar-like fluid and honey-like fluid ( P>0.05). Conclusions:The alteration of fluid viscosity did not affect healthy male biomechanical sequence of tongue, hyoid and swallowing-related muscles during normal swallowing. The biomechanics of the oropharyngeal structures is physiologically regulated with the alteration of fluid viscosity to ensure swallowing safely and smoothly.

The cause of dizziness is often phlegm-rheum, and most of them are treated with drugs, which eliminate excessive fluids. However, in recent years, the causes of dizziness have become diversified and complicated, and in some cases it is difficult to treat with general-purpose agents. This time, we present a case of chronic refractory dizziness successfully treated with goshakusan. The patient was a 70-year-old woman. She had wobbled while walking for 2 years, and consulted nearby doctors. No particular abnormality was pointed out, and oral treatment was performed, but there was no improvement. In our department, ryokeijutsukanto, hangebyakujutsutenmato, goreisan, hochuekkito, kamishoyosan, chotosan, and shinbuto were prescribed by the doctor at the first visit. However, there was no improvement, and the author took over the charge. We diagnosed her with orthostatic dysregulation and prescribed tofisopam, but her dizziness did not improve. We conducted oriental medical examination, and diagnosed that phlegm-rheum associated with food accumulation was the main pathological condition, and that qi stagnation and blood stasis were combined. After 16 weeks of administration of goshakusan, her dizziness improved.

Sleep disorders may be involved in unexplained dizziness. This time, we report 2 cases of dizziness with sleep disorders improved with keishikaryukotsuboreito. Case 1 is a 67-year-old woman. She had had vertigo attacks for 4 years, was very anxious about the attacks, had trouble falling asleep, and was aware of dizziness even between the attacks. After 4 weeks of administration of keishikaryukotsuboreito, her anxiety disappeared and she was able to sleep soundly. After 10 weeks, the lightheadedness disappeared and the medication was terminated at 17 weeks. Case 2 is a 38-year-old woman. She was exhausted because she had a personnel change in her workplace 3 months ago and she was concerned about many things. From 2 months ago, she had trouble falling asleep at night. After 2 weeks of administration of keishikaryukotsuboreito, she was able to sleep soundly. The dizziness disappeared after 6 weeks, and the medication was terminated at 10 weeks.

In cases of pulsatile tinnitus, the presence of organic disease should be suspected, and many of them can be treated once the cause is identified. However, there are idiopathic cases in which the cause cannot be identified, and there is no established treatment for them. Here, we report 2 cases in which Kampo medicine was effective for idiopathic pulsatile tinnitus. Case 1 was a 50-year-old man. He had been stressed for half a year due to the change of job title in his workplace, and he had left pulsatile tinnitus a month ago. We administered saikokaryukotsuboreito, and his tinnitus disappeared in a week. Case 2 was a 30-year-old woman. She gave birth 4 months ago, and after giving birth, she had less sleep and was tired and stressed. She started to notice right pulsatile tinnitus and dizziness from a month ago. We administered nyoshinsan, and her tinnitus and dizziness disappeared in 2 months. In both cases, they were aware of hot flashed on their face as a symptom of qi counterflow, and Kampo treatment improved the symptom together with pulsatile tinnitus. It is possible that blood flow in the head increased with qi counterflow, causing relative stenosis of the blood vessels in the head, leading to turbulence in the lumen of the blood vessels, and hearing pulsatile tinnitus.

We have reported cases of idiopathic sensorineural hearing loss treated with Japanese Kampo medicine in the past, but they all exhibited deficiency pattern. This time, we experienced cases of idiopathic sensorineural hearing loss, which exhibited medium pattern and excess pattern. Case 1 is a 57-year-old man. He had a chief complaint of ringing and hearing loss in his right ear from 3 days ago and was diagnosed with right idiopathic sensorineural hearing loss Grade3b. He exhibited medium pattern with liver qi depression and blood stasis, and was administered shosaikoto and keishibukuryogan. He was cured after 2 weeks. Case 2 is a 48-year-old man. He had a chief complaint of hearing loss in his right ear and dizziness from 2 days ago and was diagnosed with right idiopathic sensorineural hearing loss Grade4a. He exhibited excess pattern with liver qi depression and blood stasis, and was administered daisaikoto and tokakujokito for 1 week. After that, we switched tokakujokito to keishibukuryogan and continued treatment, but there remained a slight difference in hearing around the treble part, and it stopped at a remarkable recovery.

Tonsillectomy is an operation generally carried out in otolaryngology. Postoperatively, the pain is very strong and it is often difficult to eat for several days. This time, we experienced a case after tonsillectomy in which rikkosan was effective for pain management. The patient was a 23-year-old woman. With a diagnosis of habitual tonsillitis, we performed her tonsillectomy. Postoperative pain was strong, however, it was difficult to use both non-steroidal anti-inflammatory drug and acetaminophen due to the history of drug eruption. Pain was alleviated immediately after taking rikkosan Subsequently we managed pain by using rikkosan as needed. Following a good postoperative course, she was discharged 6 days after surgery.

Pruritus of external auditory canal is often treated with blood-enriching formulation and heat-clearing formula. Here, we report a case of intractable pruritus of external auditory canal successfully treated with tokishigyakukagoshuyushokyoto, which did not improve with blood-enriching formulation or heat-clearing formula. Our patient was a 52-year-old woman. She had itching in her left ear from the age of 45, and was treated by 5 otolaryngologists, but her symptom did not improve. I treated her with tokiinshi, shofusan, yokukansankachimpihange, unseiin, jumihaidokuto and keishibukuryogankayokuinin, but they had no effect. After reconsideration of sho, she was diagnosed as interior cold pattern, and she had tenderness in groin area. So I treated her with tokishigyakukagoshuyushokyoto, and her itching disappeared. We should consider interior cold pattern as one of the differential diagnoses of pruritus of external auditory canal.

We experienced 2 patients with clinical diagnosis of subacute necrotizing lymphadenitis who were successfully treated with shosaikoto. Case 1 is a 37-year-old woman. Left neck swelling and pain appeared from 12 days before, and temperature went up thereafter. Antibiotics were administered at another hospital, but she did not improve. There were multiple swollen lymph nodes of the left neck, and blood test showed decreased white blood cells and increased LDH. So we clinically diagnosed her as subacute necrotizing lymphadenitis. After administration of shosaikoto, fever resolved, and cervical swelling also markedly improved on the third day. On day 10, both symptom and findings disappeared. Case 2 is a 12-year-old man. Left neck swelling and pain appeared and temperature went up from 8 days before. An antibiotic was administered at another hospital, but he did not improve. There were multiple swollen lymph nodes of the left neck, and blood test showed decreased white blood cells and increased LDH. So we clinically diagnosed him as subacute necrotizing lymphadenitis, and administered shosaikoto. Then fever resolved on the third day, and cervical swelling diminished and tenderness disappeared on day 10. On day 18, both symptom and findings disappeared.

Background/Aims: 5-Aminosalicylic acid (ASA) causes intolerance reactions in some patients. This study was performed to examine the prognosis of patients with ulcerative colitis (UC) and 5-ASA intolerance, and to evaluate the potential interaction between 5-ASA intolerance and the intestinal microbiota. Methods: We performed a retrospective cohort study of patients with UC who visited participating hospitals. The primary endpoint was to compare the incidence of hospitalization within 12 months between the 5-ASA intolerance group and the 5-ASA tolerance group. The secondary endpoint was to compare the risk of adverse clinical outcomes after the start of biologics between the 2 groups. We also assessed the correlation between 5-ASA intolerance and microbial change in an independently recruited cohort of patients with UC. Results: Of 793 patients, 59 (7.4%) were assigned to the 5-ASA intolerance group and 734 (92.5%) were assigned to the 5-ASA tolerance group. The admission rate and incidence of corticosteroid use were significantly higher in the intolerance than tolerance group (P< 0.001). In 108 patients undergoing treatment with anti-tumor necrosis factor biologics, 5-ASA intolerance increased the incidence of additional induction therapy after starting biologics (P< 0.001). The 5-ASA intolerance group had a greater abundance of bacteria in the genera Faecalibacterium, Streptococcus, and Clostridium than the 5-ASA tolerance group (P< 0.05). Conclusions In patients with UC, 5-ASA intolerance is associated with a risk of adverse clinical outcomes and dysbiosis. Bacterial therapeutic optimization of 5-ASA administration may be important for improving the prognosis of patients with UC.