A 19-year-old woman admitted to our hospital complaining of epigastralgia. She had a habit of eating her own hair. Endoscopy and upper GI X-ray examination showed a giant trichobezoar in the stomach. Endoscopic therapy was selected because of accompanying with idiopathic thrombocytopenic purpula. Enzyme and sodium bicarbonate were administered to her, then trichobezoar was cut endoscopically. Remaining part of the trichobezoar moved and impacted to the small intestine. Acute pancreatitis occured and treatment for acute pancreatitis was performed. Finally, trichobezoar was removed. There were only two reported cases of trichobezoar removed by endoscopic therapy. We reported a rare case with giant trichobezoar removed by endoscopic therapy.
In anti-TNF agent therapy for inflammatory bowel disease, one agent should be thoroughly used because of immunogenicity issues. We examined the long-term outcomes of treatment with adalimumab (ADA) and effect of a doubled dose of ADA on treatment continuation. We retrospectively studied 103 patients with Crohn’s disease who received ADA from November 2010 through July 2018. The International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) assessment score (0 to 10) was used to evaluate disease activity. Remission was defined as a score of ≤1, and active phase was defined as a score of ≥2. The following variables were studied: (1) the rate of continuing ADA, (2) the outcomes of patients in whom short-term ADA was discontinued, and (3) the proportion of patients in whom the dose of ADA was increased and the treatment response. (1) The rate of continuing ADA was 87% at 1 year, 73% at 2 years, and 50% at 4 years. The most common reason for discontinuing ADA was loss of response (LOR), occurring in 57% of the patients. The rate of continuing ADA was significantly higher in patients whose IOIBD score at the start of treatment was ≤1 than in patients whose IOIBD score was ≥2 (p <0.05). (2) ADA was discontinued within 1 year in 14 patients (14%). The rate of discontinuing ADA decreased from 64% to 36% after coverage of a by doubled dose by insurance. Decreased numbers of patients discontinued treatment because of primary failure, LOR or bowel complications. When demographic characteristics were compared between patients who received short-term treatment and those who received treatment for 4 years or longer (n = 25), we found that the disease duration before introducing ADA was significantly shorter in patients who received long-term treatment (p < 0.05). (3) The dose of ADA was increased in 34% of the patients. The reason for a double dose of ADA was worsening of symptoms in 52% and the presence of active residual lesions on imaging studies in 48%. At the time of dose increase, the rate of continuing treatment was 100% at 0.5 year and 73% at 1 year in patients whose IOIBD score was ≤1 as compared with 75.0% at 0.5 year and 62.5% at 1 year in patients whose IOIBD score was ≥2. Low disease activity and shorter disease duration at the time of starting and increasing dose of ADA were associated with good rates of continuing treatment. Increasing the dose of ADA was associated with decreased numbers of patients who discontinued treatment because of LOR or bowel complications. Promptly increasing the dose of ADA on the detection of residual active lesions on imaging studies after the initiation of ADA can be expected to lead to the continuation of treatment and improve outcomes.
We conducted an open-label, dose titration study to assess the efficacy and tolerability of controlled-release oxycodone in the therapy of cancer pain management, starting with a newly developed 5 mg tablet every 12 h.Twenty-two Japanese cancer patients with pain who had not been taking opioid analgesics over the previous 2 weeks were enrolled. The length of time and the dose needed to attain stable and adequate pain control were evaluated in addition to the assessment of analgesic efficacy and safety during the study period.Eighteen patients in the efficacy population (18 out of 20, 90%) attained stable, adequate pain control. Two-thirds of the patients attained stable, adequate pain control without any dose titration. The mean length of time was 1.2 days. In these patients, the pain was significantly reduced in intensity, even at 1 h after the initial dose intake. Fifteen patients (68%) reported at least one side effect, but only one patient had to withdraw from the study because of a side effect.The results suggest that controlled-release oxycodone tablets offered stable and adequate pain control within a short period of time in most Japanese cancer patients who have not been taking opioid analgesics, and could be effectively titrated against pain from a starting dose of 5 mg every 12 h. This indicates that a lower strength controlled-release oxycodone formulation may make it possible to start and titrate the dose more appropriately and carefully in patients who are sensitive to opioid analgesics.
