T. Udaka, A. Taniguchi, Jun Kozai, T. Ootsuka, N. Watanabe, I. Endou, O. Yoshida, Hiroaki Asano, M. Kubo
{"title":"Predictive factors of bowel resection due to an incarcerated groin hernia","authors":"T. Udaka, A. Taniguchi, Jun Kozai, T. Ootsuka, N. Watanabe, I. Endou, O. Yoshida, Hiroaki Asano, M. Kubo","doi":"10.21203/rs.3.rs-23453/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-23453/v1","url":null,"abstract":"\u0000 Purpose\u0000\u0000In this retrospective study, we assessed factors that can be used to predict the need for bowel resection due to an incarcerated groin hernia.\u0000Methods\u0000\u0000We enrolled a total of 83 patients diagnosed with an incarcerated groin hernia on preoperative unenhanced computed tomography (CT) between January 2010 and December 2019 in our hospital. They were divided into two groups: those who underwent bowel resection and those who did not. The clinical findings, blood test results, and unenhanced CT values of patients were examined and compared between the two groups. The indication of intestinal resection was macroscopic necrosis or perforation of the incarcerated intestine.\u0000Results\u0000\u0000A total of 83 patients with incarcerated groin hernias were included in our study, of whom 13 (15.7%) had undergone bowel resection surgery. A univariate analysis identified a prolonged time from the symptom onset to surgery, increased white blood cell (WBC) count, increased C-reactive protein (CRP) level, decreased albumin level, and CT attenuation of the incarcerated intestinal wall at the fundus as significant predictive factors. The cut-off value for prediction of intestinal resection was 25 HU for the average CT attenuation of the incarcerated intestinal wall at the fundus and a WBC of 11,550 based on the receiver operating characteristic (ROC) curve. A multivariate analysis showed CT attenuation of the incarcerated intestinal wall at the fundus and an increased WBC count to be independent predictive factors.\u0000Conclusions\u0000\u0000Measuring unenhanced CT attenuation of the incarcerated intestinal wall at the fundus and the WBC count was suggested to be necessary for determining whether or not resection of the incarcerated intestine is required in cases of groin hernia.","PeriodicalId":73535,"journal":{"name":"Japanese journal of gastroenterology and hepatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67958760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Synchronous Colitis Induced by Hot Water Enema-An Easily Missed Etiology for Colitis in Modern Days","authors":"Hsu Tc, Sun Wc, Chen Mj, Lin Wc, Wang Hy","doi":"10.47829/JJGH.2020.5703","DOIUrl":"https://doi.org/10.47829/JJGH.2020.5703","url":null,"abstract":"Synchronous Colitis Induced by Hot Water Enema-An Easily Missed Etiology for Colitis in Modern Days Hsu TC1,2,3*, Sun WC1, Chen MJ3, Lin WC4 and Wang HY4 1Division of Colon and Rectal Surgery, Department of Surgery, Taipei Mackay Memorial Hospital, Taipei, Taiwan 2Department of Surgery, Taipei Medical University, Taipei, Taiwan 3Department of Surgery, Mackay Medical College, New Taipei, Taiwan 4Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan","PeriodicalId":73535,"journal":{"name":"Japanese journal of gastroenterology and hepatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70926363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S D James, A T Hawkins, J W Um, B R Ballard, D T Smoot, A E M'Koma
{"title":"The MYTHS of <i>De novo</i> Crohn's Disease After Restorative Proctocolectomy with Ileal Pouch-anal Anastomosis for Ulcerative Colitis.","authors":"S D James, A T Hawkins, J W Um, B R Ballard, D T Smoot, A E M'Koma","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>1.1.Inflammatory Bowel Disease (IBD) are the manifestation of overzealous dys-regulated immune response in the intestinal tract, directed primarily against the indigenous microbes combined with defective functioning of anti-inflammatory pathways. Finding a trustable lead to predicting <i>de novo</i> Crohn's Disease (CD) prior to performing \"pouch surgery\", Restorative Proctocolectomy (RPC) with Ileal Pouch-Anal Anastomosis (IPAA) for UC and/or Indeterminate Colitis (IC) is clinically important and remains debatable. <i>De novo</i> CD is a subsequent long-term postoperative complication in IBD patients with Ulcerative Colitis (UC) undergoing IPAA. Herewith we discuss this understanding in laboratory-based basic science research, with its molecular application as a possible corner stone tool for clinical progress and success in the IBD Clinic. Crypt Paneth cell (PCs) secreted enteroendocrine alpha-defensin 5 (<i>DEFA5</i>)\" if developed properly is likely to solve diagnostic and prognostic difficulty in IBD Clinics. <i>DEFA5</i> has shown the ability to differentiate the predominant subtypes of colonic IBD (CC <i>vs</i>. UC) at first endoscopy biopsy, avoiding diagnosis delay prior to colectomy. In addition, <i>DEFA5</i> accurately circumvents indeterminate colitis (IC) patients into accurate IBD subtype (UC or CC). Further, <i>DEFA5</i> can be used in selecting CC patients that may have positive outcomes after IPAA surgery [1]. Furthermore, likewise, <i>DEFA5</i> can predict UC patients likely to have positive or poor outcome, e.g. those patients that are likely to transform/ convert and adhere to <i>de novo</i> Crohn's after IPAA can be picked up in endoscopy biopsy before surgery.</p><p><strong>Aim: </strong>1.2.To assessed comprehensive state-of-the-art understanding domains on the <i>de novo</i> Crohn's disease subsequent to IPAA surgery for ulcerative colitis.</p><p><strong>Methods: </strong>1.3.A literature search based on preferred reporting items for over-review and meta-analysis protocols (PRISMA-P) was performed. A comprehensive current search of PubMed, MEDLINE, CINAHL, Embase, Google<sup>®</sup> search engine and Cochrane Database of collected reviews was performed from January 1990 through December 2018. The search consists of retrospective studies and case reports of reporting postoperative <i>de novo</i> CD incidence and adverse events. Secondary and hand/manual searches of reference lists, other studies cross-indexed by authors, reviews, commentaries, books and meeting abstracts were also performed. Studies were included only if the diagnosis of <i>de novo</i> CD was established clinically and histologically based on inflammation of afferent limb(s) or perianal disease. The search excluded non-English language and non-human studies as well as editorials.</p><p><strong>Results: </strong>1.4.Published data on <i>de novo</i> CD developing after RPC with IPAA are still limited. A total of three hundred a","PeriodicalId":73535,"journal":{"name":"Japanese journal of gastroenterology and hepatology","volume":"3 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10427206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10075805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pneumobilia","authors":"Fekaj E","doi":"10.47829/jjgh.2020.5701","DOIUrl":"https://doi.org/10.47829/jjgh.2020.5701","url":null,"abstract":"","PeriodicalId":73535,"journal":{"name":"Japanese journal of gastroenterology and hepatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70926251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohamed Wm, Al-Ani Uft, Hathcock Ma, Alshewered As
{"title":"Colon Versus Rectal Cancers among Surgical Approach: An Observational Study","authors":"Mohamed Wm, Al-Ani Uft, Hathcock Ma, Alshewered As","doi":"10.47829/jjgh.2020.5604","DOIUrl":"https://doi.org/10.47829/jjgh.2020.5604","url":null,"abstract":"1. Abstract 1.1. Background: Colorectal cancer is the most common tumor of the gastrointestinal tract, and it is the third leading cause of mortality throughout the world. 1.2. Objectives: An observational study of colorectal cancers. 1.3. Methods: The research was carried out in Abu Ghraib General hospital in the period from January 2019 to May 2019. The primary data reported included colorectal cancer, and patients study characterizes. These including gender, age, family history, smoking, comorbidity, IBD, tumor sites, histopathology, stages, grading, the distance for anal verge, local recurrence, distant metastasis, type of surgery, and chemoradiation. 1.4. Results: The gender was composed of male 40%, and female 60%, with mean age, was 44.89±21.6 years for males and 47.55±20.07 years for females. There was only 4% had a positive family history. Smoking patients in this study were 48%, yet the non-smoker patients were 52%. Rectosigmoid cancer represented the most common site of cancer figured in 40% of patients. The results showed that adenocarcinoma was the most common histopathology in 72% of patients. The localized tumors were recorded in 44%, whereas metastasis was found in 34% of patients. Regarding grading, the moderate differentiation was the dominant grade in 60%. The tumor distant from anal verge results exhibited as <5 cm in 7(14%), 5-10 cm in 30(60%), and >10 cm in 13(26%). The majority of patients in our study have no metastatic disease 66%. Indeed, the hepatic was the most frequent site of distant metastasis. All patients underwent different surgical procedures. 1.5. Conclusions: Middle age group was mostly effect and more in the female gender. Many factors are shown to increase the risk of developing colorectal cancer including increasing age; consumption of processed meat, and smoking. Rectosigmoid cancer represented the most current sites. The localized diseases were common. Moderate differentiation was the dominant grade. The tumor location and the distal tumor margin are essential factors upon which the surgical plan for patients with rectal cancer is based. Accurate measurement of the distal tumor margin is necessary for planning the surgical procedure. The liver was the most frequent site of distant metastasis that figured. 2. Introduction The highest colon cancer incidence rates are found in parts of Europe (eg, in Hungary, Slovenia, Slovakia, the Netherlands, and Norway), Australia/New Zealand, Northern America, and Eastern Asia (Japan and the Republic of Korea, Singapore [in females]), with Hungary and Norway ranking first among males and females, respectively [1]. The incidences are elevated in Uruguay among both men and women. Rectal cancer incidence rates have a similar regional distribution, although the highest rates are seen in the Republic of Korea among males and Macedonia among females [1]. Rates of both colon and rectal cancer incidence tend to be low in most regions","PeriodicalId":73535,"journal":{"name":"Japanese journal of gastroenterology and hepatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70926097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A M Herman, A T Hawkins, S D James, B R Ballard, A E M'Koma
{"title":"Inflammatory Bowel Disease On-Line Web-Based Guide to Health Professionals and Patients in Developing and African Nations.","authors":"A M Herman, A T Hawkins, S D James, B R Ballard, A E M'Koma","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>1.1.Inflammatory Bowel Disease (IBD) is recklessly evolving worldwide as incautious disaster, especially in developing nations as a regional duplicitous emergence disease. It has come to light that adaptive Western culture, rapid urbanization lifestyle in the developing nations has been seen to be associated with this increasing trend incidence. Apparent unclassified strategic challenge assessment of how key trends and uncertainties might lead the world over the next decades to help developing nations and plan for the long term. Healthcare professionals are faced with limited resource and unequipped laboratories for IBD diagnostics, prognostics and monitoring management. Limited knowledge on IBD among developing nation's physician's/healthcare providers is painstaking and indisputable challenge. With the emergence of advanced communications technology, the internet offers diverse, substantial, easily accessible, and educational resources that are more time- and cost-efficient than conventional modes of knowledge acquisition. An On-Line Web-Based Resources about IBD, as a guide would greatly assist health professionals and patients.</p><p><strong>Methods: </strong>1.2.We performed a literature search according to PRISMA-P (preferred reporting items for review and meta-analysis and searches in PubMed (MEDLINE database) to identify and select peer-reviewed articles allied to web-based educational accoutrements for IBD.</p><p><strong>Results: </strong>1.3.In developing nations, locally trained physicians have limited knowledge on IBD. Mostly, IBD is not included in their training Core Curriculum and research in this field/area is limited in these countries. The healthcare approaches, both at the primary care and referral levels, many times lack the essential regular clinical guidance and laboratory evaluation assessments needs for monitoring patients. Moreover, increasing treatment costs impose additional burden on the healthcare systems. Expensive pharmacological biosimilar and biologic agents/drugs, new treatment targets, and new quality indicators in patient health quality of life and care are significant challenge in addition to early manifestations of IBD are likely to be missed at most health institutions.</p><p><strong>Conclusion: </strong>1.4.We herewith summarize an on-line web-based e-learning guide for IBD-related educational resources to assist physicians, healthcare personnel and patients worldwide, especially in the developing nations where the epidemiological monitoring studies are limited, due to a lack of medical surveillance systems and reliable and unified registries and databases.</p>","PeriodicalId":73535,"journal":{"name":"Japanese journal of gastroenterology and hepatology","volume":"3 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10446829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10104455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Oropharyngeal Transition during Swallowing between Stroke and Head and Neck Cancer Survivors","authors":"C. Deckelman, Y. Kim, T. Park","doi":"10.47829/jjgh.2020.5405","DOIUrl":"https://doi.org/10.47829/jjgh.2020.5405","url":null,"abstract":"1. Abstract 1.1. Objective: The purpose of this study was to analyze three oropharyngeal bolus transition timings, Oral Transition Time (OTT), Pharyngeal Transition Time (PTT), and Duration of Upper Esophageal Sphincter Opening (DUESO), using videofluoroscopic swal lowing examinations (VFSEs) between stroke survivors and head and neck cancer survivors to determine differences between the two populations. 1.2. Methods: Means and standard deviations of OTT, PTT, and DUESO were determined from analyzing two 5ml thin liquid swallows exhibited by each of the 15 stroke survivors and 15 head and neck cancer survivors from the VFSEs. Statistical analyses were made using one-way analysis of variance (ANOVA) using the two groups with the statistical level set at p < .05.","PeriodicalId":73535,"journal":{"name":"Japanese journal of gastroenterology and hepatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70925928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Concurrent Gastric Hyperplastic and Fundic Gland Polyps in a Patient Taking Proton-Pump Inhibitor","authors":"N. Nishimura, M. Mizuno","doi":"10.47829/jjgh.2020.5603","DOIUrl":"https://doi.org/10.47829/jjgh.2020.5603","url":null,"abstract":"1. Clinical Image A 61-year-old man presented with iron-deficiency anemia (hemoglobin, 8.1 g/dl). He had been taking warfarin and low-dose aspirin for atrial fibrillation and post mitral valve replacement. He had also taken 15 mg lansoprazole daily for 6 years for treatment of gastroesophageal reflux disease. Serum anti-Helicobacter pylori IgG antibody and H. pylori testing of gastric biopsies were negative. Esophagogastroduodenoscopy revealed more than 20 pale pink, pedunculated polyps of up to 20-mm diameter (Figure 1) and fewer light-red polyps in the gastric body and fundus. The fundic mucosa appeared non-atrophic. The largest of the pale pink polyps and one large, red polyp (Figure 2) were resected endoscopically. Histological examination of the pale pink polyp revealed fundic gland mucosa with cystic, dilated glands, consistent with fundic gland polyp. Histological examination of the large, red polyp revealed elongation and branching of foveolae, characteristic of a hyperplastic polyp, without atypia, (Figure 3). Lansoprazole was discontinued because of suspected association between its use and gastric polyps. Follow-up endoscopy 5 months later revealed fewer and smaller gastric polyps (Figure 4). The anemia had resolved with iron treatment and did not recur. Gastric fundic grand polyps develop with long-term use of proton-pump inhibitors [1]. Hyperplastic polyps usually occur in patients with H. pylori infection [2], but association between use of the medication and hyperplastic polyps is unclear. This case demonstrates that long-term PPI therapy induces the development of gastric hyperplastic polyps and fundic gland polyps in patients without H. pylori infection. Figure 1: Esophagogastroduodenoscopy revealed more than 20 pale pink, pedunculated polyps of up to 20-mm diameter in the gastric body.","PeriodicalId":73535,"journal":{"name":"Japanese journal of gastroenterology and hepatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70926019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Granata, M. Amata, Monteiro Ld, D. Ligresti, M. Traina, A. Bertani
{"title":"Proximal Esophageal Anchored Stent: A Successful Endoscopic Approach in A “Troublesome” Location","authors":"A. Granata, M. Amata, Monteiro Ld, D. Ligresti, M. Traina, A. Bertani","doi":"10.47829/JJGH.2020.5705","DOIUrl":"https://doi.org/10.47829/JJGH.2020.5705","url":null,"abstract":"1. Case Report A 71-year-old woman was admitted for the surgical treatment of a pulmonary adenocarcinoma of the right upper lobe. During anesthesia induction, a left Robertshaw endotracheal tube (ETT) was inadvertently placed in the esophagus. After successful bronchoscopic ETT repositioning, the patient underwent an uneventful VATS (Video-Assisted Thoracoscopic Surgery) right upper lobectomy and lymphadenectomy. High-flow (>1liter) output of particulate white fluid through the chest tube was noted on first post-operative day (POD). In the suspicion of chylothorax, an exploratory esophagogastroduodenoscopy and VATS were performed and a 4-cm longitudinal tear of the posterior wall of the esophagus was found just below the thoracic inlet. The lesion was repaired with a double layer, interrupted 4-0 polydioxanone suture and the chest drained. On POD#7, a barium swallow showed adequate resolution of the fistula. Nevertheless, after initiation of oral intake, the patient developed fever and dysphagia. Endoscopy showed a minimal, 2-mm residual esophageal dehiscence located 2 cm under the cricopharyngeal sphincter, and a CT-scan (Figure 1) showed a residual upper mediastinal collection. Immediate endoscopic clipping of the fistula was attempted but failed due to inadequate margin apposition. After multidisciplinary discussion and despite the very proximal location of the lesion, a fully-covered self-expandable metal stent (FCSEMS, 80x20 mm; Niti-S, Taewoong Medical, South Korea) was deployed in the esophagus and centered on the fistula. In order to avoid distal migration, the proximal end of the stent was sutured to the esophageal wall, just below the cricopharyngeus, using the OverStitch Endoscopic Suturing System (Apollo Endo-surgery, Austin, Texas) (Video). The FC-SEMS was left in place for two months and allowed complete resolution of the fistula. It was then removed endoscopically using a novel cutting device (Ensizor Flex, Austin, Texas) (Figure 2). The final examination revealed definitive healing of the esophageal wall (Figure 3). The patient is alive and well at 11-months follow-up. Esophageal perforation is a rare life-threatening complication of orotracheal intubation, occurring more frequently after difficult cases and double-lumen tube placement, which is a stiffer and sharper device than a standard, single-lumen tube [1, 2]. Endoscopic management of esophageal perforations allows avoiding repeated surgical revisions in patients who are often infected and debilitated. Esophageal lesions located in the proximal esophagus may be very difficult to approach with endoscopic techniques. Endoscopic stenting and anchoring with endo suturing systems may overcome these limitations and may be a further important tool for the interventional endoscopist.","PeriodicalId":73535,"journal":{"name":"Japanese journal of gastroenterology and hepatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70926302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Therapeutic Drug Monitoring of Thiopurine Therapy in Patients with Inflammatory Bowel Disease","authors":"Zalizko P, J. I., Pukitis A","doi":"10.35665/2435-1210.2019.1017","DOIUrl":"https://doi.org/10.35665/2435-1210.2019.1017","url":null,"abstract":"The aim of this study and review was to make a comparative TPMT enzyme activity analysis using TPMT enzyme expression determination method in IBD patients who are already taking azathioprine drug therapy, with patients who have not yet begun this therapy. The longterm aim is to decrease overall expenses using azathioprine, that could be done if patients would be tested for TPMT expression level before starting therapy with azathioprine, thereby excluding this therapy for patients with higher risk of adverse side effects, reducing medical expenses treating these side effects.","PeriodicalId":73535,"journal":{"name":"Japanese journal of gastroenterology and hepatology","volume":"175 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41287005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}