橋本 千樹

In Japan, the establishment of diagnostic criteria for acute-on-chronic liver failure (ACLF) in 2022 has increased the focus on alcoholic hepatitis. Most hospitals in Japan lack specialized treatment units or psychiatrists for managing alcohol use disorders, leaving hepatologists to handle various aspects of the disease-a challenging task. This study retrospectively investigated the outcomes of alcoholic hepatitis in a typical Japanese hospital setting, stratified by ACLF diagnosis and other features, with the aim of identifying areas for possible improvement. We conducted a retrospective analysis of 88 patients hospitalized with alcoholic hepatitis, reviewing records for the diagnosis of ACLF or related conditions, development of delirium tremens (DT), risk factors, and patient outcomes. Patients meeting the Japanese criteria for ACLF or related conditions had significantly worse survival outcomes. DT developed in 13 patients, with low platelet counts and elevated γ-glutamyl transpeptidase levels identified as risk factors. Prophylactic oral benzodiazepines were found safe and significantly associated with preventing DT. Onset of DT during hospitalization did not measurably impact survival prognosis, but DT patients showed a tendency to break contact with our hospital and critical events may have been missed. While under hepatologist care, patients typically maintained sobriety, but relapse into alcohol-related health problems frequently occurred after follow-up was discontinued. In Japan, hepatologists may be missing important events with alcoholic hepatitis after follow-up discontinuation, especially in patients with DT. Therefore, integrated and collaborative care, particularly a psychosocial approach providing behavioural support, may reduce risk of relapse and improve patient prognosis. TRIAL REGISTRATION: All study protocols were reviewed and approved by the ethics committee at Fujita Health University School of Medicine (approval no. HM23-213).

The new Kyoto guidelines for the management of intraductal papillary mucinous neoplasm (IPMN) provide evidence-based recommendations for the diagnosis and treatment of IPMN. Endoscopic ultrasonography (EUS) is a diagnostic modality with a high spatial resolution that allows detailed observation and obtaining cyst fluid or tissue samples via EUS-guided fine needle aspiration (EUS-FNA). Currently, EUS is an indispensable examination method for the diagnosis of pancreatic diseases. On the other hand, there have been concerns that EUS imaging tends to be highly operator-dependent, and may lack objectivity. Previous guidelines have assigned EUS as an option for patients with worrisome features. However, recent reports indicate that the sensitivity of EUS for the diagnosis of mural nodules (MNs) is more than 90%, comparable or superior to that of contrast-enhanced computed tomography or magnetic resonance cholangiopancreatography. The specific advantages of EUS in the diagnosis of IPMN are: (1) high spatial resolution imaging for the diagnosis of MNs, (2) contrast-enhanced EUS for differentiation of intra-cystic MNs from mucous clots, and (3) pathological diagnosis using EUS-FNA and differential diagnosis of a pancreatic cystic tumor by cystic fluid analysis. In order to utilize EUS in the diagnosis of IPMN, endoscopists are required to have the skills to provide sufficiently objective imaging findings.

Less than half of all patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) respond to chemotherapy, and the prognosis of PDAC is poor, which may be mediated by the gut microbiota. We investigated the clinical improvement effects of 1-kestose, a fructooligosaccharide, on PDAC chemotherapy in this single-center, randomized, controlled pilot trial conducted at Fujita Health University Hospital, which enrolled patients with PDAC. The trial included 1-kestose administration and non-administration groups. The 1-kestose group received 9 g of 1-kestose daily for 12 weeks, and their blood markers, imaging studies, physical findings, and gut microbiota were evaluated. In the 1-kestose administration group, the cancer marker CA19-9 significantly decreased, and there was a reduction in the neutrophil-to-lymphocyte ratio (NLR). There was also suppression of the reduction of albumin levels and of an increase in C-reactive protein. Additionally, Escherichia coli, which typically increases in PDAC, significantly decreased in the 1-kestose group. Thus, 1-kestose altered the gut microbiota and improved the prognostic factors for PDAC. Large-scale, long-term trials of 1-kestose interventions for PDAC are thus warranted to improve the prognosis of PDAC.