Background/Aims: The Lyon Consensus defined parameters based on upper endoscopy and 24-hour combined multichannel intraluminal impedancepH (MII-pH), that conclusively establish the presence of gastroesophageal reflux disease (GERD). However, the true role of upper endoscopy and MII-pH to evaluate patients with extraesophageal symptoms (EES) has not been well established. Hypopharyngeal MII (HMII), which directly measures laryngopharyngeal reflux (LPR) events, has been utilized to evaluate patients with EES suggestive of LPR. Methods: This was a retrospective study involving patients with EES for > 12 weeks despite proton pump inhibitor therapy, and had no endoscopic confirmatory evidence for GERD and negative MII-pH. All patients were subsequently referred for further evaluation of EES with “unknown” etiology and underwent laryngoscopy and HMII. Based on HMII, abnormal proximal exposure (APE) was defined as LPR ≥ 1/day and/or full column reflux (reflux 2 cm distal to the upper esophageal sphincter) > 4/day. Patients with APE were offered antireflux surgery (ARS) and the outcome of ARS was objectively assessed using Reflux Symptom Index. Results: Of 21 patients with EES which was thought to be GERD-unrelated based on endoscopy and MII-pH, 17 patients (81%) had APE. Eight patients with APE who had undergone ARS had significant symptomatic improvement in the Reflux Symptom Index score (19.6 ± 4.9 pre-ARS to 5.8 ± 1.4 post-ARS, P = 0.008). Conclusions A conventional diagnostic approach using endoscopy and MII-pH may not be sufficient to evaluate patients with EES suggestive of LPR. HMII is essential to evaluate patients with EES, and APE could be a reliable indicator for successful treatment outcomes.

Objective : In 2011, the Ishikawa Prefectural Joint Committee of Blood Transfusion Therapy was organized in Ishikawa Prefecture. Since 2012, pharmacists have promoted educational activities regarding the appropriate use of albumin products for different occupations based on a survey involving all medical institutions in Ishikawa Prefecture. We examined the effects of these activities with respect to the usage of albumin products. Methods : A questionnaire survey regarding blood transfusion therapy, including the total usage of albumin products, departments responsible for the management of albumin products, and health care professionals’ awareness of issues on the appropriate use of albumin products, was conducted from 2011 until 2014 involving all medical institutions where blood transfusion preparations were used in Ishikawa Prefecture. Results : The questionnaire collection rate was ≥70%. The results showed that, in middle- or small-scale medical institutions, departments/physicians other than the Department of Pharmacy were responsible for the management of albumin products. Furthermore, some health care professionals did not recognize/understand problems regarding the appropriate use of albumin products. Pharmacists newly increased educational activities by study meetings for various occupations or panel discussions involving participants. The participants’ occupations varied, and the number of institutions to which they belonged was 20 to 24. The total usage of albumin products in Ishikawa Prefecture decreased by approximately 20% between 2011, when these attempts were started, and 2014. Discussion : This study suggests that the educational activities by pharmacists and other health care professionals at the prefectural level reduced the total usage of albumin products.

Ulcerative colitis (UC) is one of the major clinical phenotypes of inflammatory bowel diseases. Although 5-aminosalicylic acid (5-ASA) is widely used for UC and its efficacy and safety have been demonstrated, a few patients paradoxically develop a severe exacerbation of colitis by 5-ASA administration. It is crucial to know clinical features including endoscopic findings in this condition for making a correct diagnosis and a prompt decision to withdraw the medication. Here, we report case series with UC exacerbated by 5-ASA. Medical records of 8 UC patients experiencing an exacerbation of colitis after induction of 5-ASA that was improved by the withdrawal of 5-ASA but also re-aggravated by dose increase or re-administration of 5-ASA were reviewed. The patients were newly diagnosed with UC, started 5-ASA and developed an exacerbation in approximately 2 to 3 weeks. They did not appear to have systemic allergic reactions. Seven of the 8 patients had a high fever. Three of 5 patients who undertook total colonoscopy showed right-side-dominant colitis. These findings suggest clinical characteristics in this condition. Further assessment of clinical and endoscopic features in more cases is necessary for establishing diagnostic criteria and understanding underlying mechanisms in those cases where 5-ASA aggravates the colitis.
Colitis* ; Colitis, Ulcerative* ; Colonoscopy ; Diagnosis ; Fever ; Humans ; Hypersensitivity ; Inflammatory Bowel Diseases ; Medical Records ; Mesalamine* ; Phenotype ; Ulcer*

Characteristics of low attenuation area (LAA) of the lungs on HRCT were studied in 132 patients with asthma, and long-term spa therapy on the LAA of the lungs was observed in 5 patients with asthma, whose me an %LAA was more than 30%.
1. The morphology of LAA of the lungs on HRCT observed in asthma was different from that in pulmonary emphysema. 2. The LAA of the lungs in asthma was closely related to residual volume (RV). 3. The mean %LAA value significantly decreased from 33.5% before spa therapy to 24.5% at 24 months after beginning of the therapy. CT number also significantly increased after long-term spa therapy. 4. %FEV1.0 value significantly improved from 52.1% before spa therapy to 72.1% at 24 months after spa therapy. The RV value also decreased by spa therapy, however, the decrease was not significant. These results suggest that LAA of the lungs in asthma is associated with hyperinflation, and the LAA of the lungs decreases after long-term spa therapy.

Clinical effects of spa therapy for patients with pulmonary emphysema (PE) were evaluated by observing changes in %LAA of the lung on HRCT, %RV, %FVC, %FEV 1.0, and %DLco values after the long-term therapy. The subjects in this study 16 patients with PE. The subjects were divided into two groups according to the extent of %LAA<-950 HU of the lung on HRCT: %LAA<50% (N=6) and 50%≤%LAA (N=8). 1. Spa therapy significantly improved %LAA (42.5% at the initial stage to 36.3% 24 months after spa therapy), %RV (202.1% to 156.1%) and %DLco 71.0% to 85.7%), but not %FVC and %FEV 1.0, in patients with PE of %LAA<50%, however, significant. Improvement of these parameters was not observed in patients without spa therapy. 2. Spa therapy did not improve the values of %LAA, %RV, and %DLco, as well as %FVC and %FEV 1.0, in patients with PE of 50%≤%LAA. These parameters tended to decrease in the patients of 50%≤%LAA. These results suggest that spa therapy improves %LAA and parameters related to pulmonary function when they are at early stage of PE, however, the therapy was not remarkably effective for these parameters when they were at advanced stage of PE.

Spa therapy has been performed at our medical center for last 20 years. The changes in number and frequency of patients with respiratory disease were analyzed every 5 year for last 20 years. The total number of patients with respiratory disease who were admitted at our medical center for last 20 years was 1934, of whom the number of patients with asthma was 1226 (63.4%), and the number of those with COPD was 415 (21.5%). The number of patients with asthma treated with spa therapy showed a tendency to increase form 57 for the first 5 years (first stage) to 465 for the last 5 years (forth stage). The number of patients with COPD also increased from 26 for the first 5 years to 227 for the last 5 years. The frequency of SDIA decreased from 68.4% for the first 5 years to 29.0% for the last 5 years. In contrast, the frequency of pulmonary emphysema increased 19.2% at the first stage to 76.7% at the forth stage. The number and frequency of elderly patients with asthma and COPD over the age of 60 tended to increase for last 20 years.

N-3 fatty acids are reportedly effective for asthma. In addition, spa therapy has been reported to be effective for patients with asthma. In the present study, the effects of spa therapy combined with perilla seed oil-rich diet (rich in n-3 fatty acid) were examined on asthma. A total of 14 asthmatic patients had a complex spa therapy and consumed a perilla seed oil-rich diet-rich in α-linolenic acid (α-LNA) for 8 weeks. Generation of leukotriene (LT) C4 by leucocytes, respiratory function were analyzed. The generation of LTC4 by leucocytes decreased significantly for 2, 4 and 8 weeks (P<0.05). Peak expiratory flow (PEF) values increased significantly for 2, 4, 6 and 8 weeks (P<0.05). The values of ventilatory parameters [forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), forced expiratory flow after 25% of expired FVC (FEF₂₅), forced expiratory flow after 75% of expired FVC (FEF₇₅), mean expiratory flow during the middle half of the FVC (FEF_25-75)] revealed a significant increase after 4 and 8 weeks of the modified diet (P<0.05). The results suggest that spa therapy combined with a perilla seed oil-rich diet are effective in the treatment of asthma in terms of its ability to suppress LTC4 generation by leucocytes, and in inducing an improvement of pulmonary function.

Effects of spa therapy on asthma were studied in 64 patients with asthma in relation to the generation of leukotrienes B4 (LTB4) and C4 (LTC4) and bronchial hyperresponsiveness. 1. The efficacy of spa therapy was marked in 12 (18.8%), and moderate in 45 (70.3%) of 64 patients with asthma, and slight or no efficacy of the therapy was observed in the residual 7 patients (10.9%). 2. Bronchial hyperresponsiveness to methacholine was the highest in patients with slight or no efficacy of spa therapy, however, there were no significant differences among the three groups classified by clinical efficacy. 3. The generation of LTC4 by leucocytes was significantly higher in patients with slight or no efficacy compared with the generation in those with marked (p<0.01) and moderate efficacy (p<0.001). However, there were no significant differences in the generation of LTB4 among them. 4. The generation of LTC4 before spa therapy significantly decreased in patients with marked (p<0.001) and moderate efficacy (p<0.01) after spa therapy, but not in those with slight or no efficacy. The generation of LTB4 was not significantly different before and after spa therapy among patients with marked, moderate, and slight or no efficacy. These results show that the efficacy of spa therapy for patients with asthma is closely related to the generation of LTC4 by leucocytes, and that the generation of LTC4 significantly decreases after spa therapy in patients with spa efficacy.