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Study of the Completion of Follow-up After Helicobacter pylori Eradication Therapy Yusaku Kajihara; Tadashi Shimoyama
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 3 (2018): VOLUME 19, NUMBER 3, December 2018
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Because no therapeutic regimens have an eradication rate of 100%, post-treatment evaluation is necessary to ensure that adequate eradication therapy for Helicobacter pylori has been provided. The fact that not all patients are evaluated after eradication therapy is a serious concern for both the medical care system and medical economy.Method: We performed a retrospective study of 411 patients who received first-line H. pylori eradication therapy at Fuyoukai Murakami Hospital from October 1, 2014 to March 31, 2016. We calculated the rate of post-treatment follow-up at 1 year after completing the eradication therapy. In addition, we excluded 76 patients who definitely received post-treatment evaluation because of follow-up appointments with gastroenterologists (n = 29) or return visits to other physicians (n = 47) and included 335 patients in the final study population. We used logistic regression models for identifying the relevant factors contributing to the completion of post-eradication follow-up.Results: The rate of completion of post-eradication follow-up was 78.8% (324/411). Multivariate analysis revealed that the adjusted odds ratios for age (≥ 48 years), gender (female) and preventive measures for gastric cancer (esophagogastroduodenoscopy after radiographic screening for gastric cancer and a desire to be examined for H. pylori infection) were 1.85 [95% confidence interval (CI): 1.11–3.09; p 0.05], 1.89 [95% CI: 1.07–3.34; p 0.05] and 4.01 [95% CI: 1.61–10.0; p 0.01], respectively.Conclusion: Age ≥ 48 years, female gender and preventive measures for gastric cancer were independently related to a higher rate of completion of post-eradication follow-up.

Usefulness of semi-solid medical foods administered after percutaneous endoscopic gastrostomy Yusaku Kajihara
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 22, No 2 (2021): VOLUME 22, NUMBER 2, August 2021
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Even if preoperative enteral nutrition is administered without any issues, some patients suffer from gastrointestinal symptoms (e.g., vomiting and diarrhea) after initiating gastrostomy feeding. Because of the amino acid composition and limited amount of lipids, elemental diets may reduce the risk of gastrointestinal symptoms. However, elemental diets are expensive. Semi-solid medical foods are inexpensive and more closely mimic normal physiology than elemental diets. The aim of the present study was to investigate the usefulness of semi-solid medical foods when administered after percutaneous endoscopic gastrostomy (PEG).Method: This retrospective study analyzed 91 patients who had PEG performed by the author who was the attending physician. All patients received preoperative enteral nutrition with liquid nutrients, and there were no instances of gastrointestinal symptoms before PEG tube placement. The types of nutrients administered after PEG were divided into three categories: semi-solid medical foods (n = 20), polymeric formulas (n = 26), and elemental diets (n = 45). The incidence of gastrointestinal symptoms was compared among the three groups.Results: No gastrointestinal symptoms occurred in the semi-solid medical foods group; the incidence of gastrointestinal symptoms in the semi-solid medical foods group was significantly lower than that of the polymeric formulas group [0% vs. 26.9% (7/26), p 0.05] and was similar to that of the elemental diets group [0% vs. 2.2% (1/45), p = 1].Conclusion: If preoperative enteral nutrition is administered without any issues, semi-solid medical foods are useful as nutrients administered after PEG tube placement.

Sex-specific Differences in Response to First-line Helicobacter pylori Eradication Therapy with vonoprazan, amoxicillin, and clarithromycin Yusaku Kajihara
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 20, No 3 (2019): VOLUME 20, NUMBER 3, December 2019
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Although gender medicine has been promoted in medical research and patient care, limited information is available on sex-specific differences in response to first-line Helicobacter pylori eradication therapy. Therefore, this retrospective study investigated sex-specific differences in response to first-line H. pylori eradication therapy with vonoprazan, amoxicillin, and clarithromycin.Method: The study included 314 patients who received vonoprazan-based triple therapy (20 mg vonoprazan, 750 mg amoxicillin, and 200 or 400 mg clarithromycin; twice daily for 7 days) as first-line H. pylori eradication therapy at Fuyoukai Murakami Hospital from March 1, 2015, to April 30, 2019. First-line eradication rates were determined by intention-to-treat (ITT) and per protocol (PP) analyses. Sex-specific differences in the rate of drug-related treatment-emergent adverse events (TEAEs) were also monitored. Fisher’s exact test was used for identifying sex-specific differences.Results: First-line eradication rates were 95% in ITT and PP analyses regardless of sex, without significant sex-specific differences [ITT analyses: males 95.3% (203/213) vs. females 96.0% (97/101), p = 1.0; PP analyses: males 95.3% (203/213) vs. females 96.0% (95/99), p = 1.0]. However, the rate of drug-related TEAEs was significantly higher in females than in males [males 4.2% (9/213) vs. females 17.8% (18/101), p 0.001]. In particular, skin rash occurred only in females [males 0% (0/213) vs. females 10.9% (11/101), p 0.00001].Conclusion: Females experienced more drug-related TEAEs than males during first-line H. pylori eradication therapy with vonoprazan-based triple therapy. In particular, skin rash was observed only in females.

Risk Factors for Gastrointestinal Symptoms post Enteral Nutrition Initiation via a Gastrostomy Tube Yusaku Kajihara
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 21, No 3 (2020): VOLUME 21, NUMBER 3, December 2020
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Percutaneous endoscopic gastrostomy (PEG) facilitates long-term enteral nutrition. However, parenteral nutrition prior to PEG tube placement can cause impaired gastrointestinal function. Additionally, upon initiation of enteral feeding via a PEG tube, some patients suffer from gastrointestinal symptoms (e.g., vomiting, diarrhea), which reduce their quality of life and increase the nursing workload.Method: This retrospective study included 155 patients upon whom the author performed PEG as the attending physician. Enteral nutrition was started through the PEG tube on the third day after its placement. The following characteristics were analyzed: age, gender, indications for PEG, preoperative enteral nutrition, administered liquid nutrients, daily dosage of nutrients, serum albumin levels, serum alanine aminotransferase levels, serum creatinine levels, serum hemoglobin levels, and vomiting or diarrhea within seven days after the initiation of PEG feeding. A logistic regression model was used to identify the risk factors contributing to gastrointestinal symptoms, and three variables were sequentially introduced into the model—preoperative non-enteral nutrition, hypoalbuminemia, and administration of non-elemental diets.Results: Vomiting and diarrhea occurred in 10 and 15 patients, respectively. There were significant differences in administered nutrients and serum albumin levels between patients with and without gastrointestinal symptoms. Multivariate analysis revealed that the adjusted odds ratios for administration of non-elemental diets and serum albumin level ≤3.2 g/dL were 8.05 (95% confidence interval (CI): 2.66–24.4; p 0.001) and 3.81 (95% CI: 1.33–10.9; p 0.05), respectively.Conclusion: The administration of non-elemental diets and a serum albumin level ≤3.2 g/dL were significant risk factors.

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