Functional dyspepsia (FD) is a group of gastrointestinal (GI) disorders that includes variable combinations of chronic or recurrent upper GI symptoms not explained by structural or biochemical abnormalities. FD accounts for a significant percentage of patients seen in primary care with abdominal symptoms. Although the criteria used to define FD can easily affect the prevalence in the general population, the prevalence of uninvestigated dyspepsia and FD diagnosed by the Rome III criteria is 5.3% to 20.4%, predominantly affecting females. The prevalence differs among geographical regions and races. Gene polymorphisms and early life events are also involved in the development of FD. The symptoms often alleviate and re-appear in the course of these entities. This information may introduce physicians to the detailed background of these patients and strategies for treatment.

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Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are functional diseases without identified organic cause and intruduced as part of the Rome III criteria published in 2006. Because of non-organic diseases, pharmacological treatment (not invasive surgical treatment) is the preferred therapy for such diseases. Meanwhile, evidence-based clinical practice guidelines for FD and IBS have been published in Japan. However, no definite therapeutic strategy for FD and IBS has yet been established. To understand more appropriate treatments according to the respective pathophysiology, this review introduces the several pharmacological treatments including current standards and proposes future promising therapies based on these guidelines. First, this review covered clinical evidence for standard and recommended drugs such as acid suppressants, prokinetics, probiotics, and bulking polymers for the management of FD and IBS. Next, this review progressed to propose future promising treatments for their managements. A comprehensive understanding of relevant therapeutic regimens and pharmacological treatment using drug candidates including future promising drugs is required for the optimal and more effective treatment of FD and IBS.

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Asthma runs strongly in families and has a heritability rate of up to 60%. Genetic studies offer a structured means for understanding the causes of asthma and for identifying targets of treatment for the syndrome. As with studies of other common complex diseases, genetic studies of asthma have led to considerable advances in the understanding of this disease. Genome-wide association studies have greatly advanced the identification of the most important genes predisposing individuals to airway diseases. Several genes act in pathways that communicate the presence of epithelial damage to the adaptive immune system ; identification of these genes has provided a new focus for the development of effective therapies. Genetic findings have also led to a reassessment of the primacy of atopy in asthma and eczema (atopic dermatitis) ; these findings indicate that atopy is secondary to epithelial damage or other events in both diseases. Despite these advances, only a small component of the overall genetic contribution to asthma has been identified. This missing heritability may be due to multiple genes of small effects (polygenes), rare highly penetrant mutations, or epigenetic modifications of gene function. Further work is necessary to understand the biological consequences of the known susceptibility variants ; the most immediate challenge in this field is the systematic analysis of the precise functions of these genes in the pathogenesis of asthma. Detailed functional dissection of the roles of these genes in asthma will point the way to new therapies for the disease.

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Despite massive intervention from Japan’s national and local governments, the skewed distribution of physicians remains a serious social problem. This review paper summarizes past literature and proposes a future strategy to deal with this sophisticated issue based on scientific evidence. There are several ways to achieve a more balanced distribution, the most feasible of which is to increase the number of generalists. This increase might be imminent with the establishment of a formal board certification for general practitioners (sougou-shinryou-i) and raising the number of rural subquota (chiikiwaku) entrants to medical school. All the stakeholders should co-operate to take advantage of this great opportunity to increase the number of generalist physicians and solve Japan’s distribution problem.

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Seminal plasma allergy (SPA) is an immunological reaction against human seminal plasma observed in women. SPA is not a well-known clinical syndrome, considering that there are few epidemiological studies on SPA, and it can often be overlooked or misdiagnosed as other medical conditions. Symptoms occur after sexual intercourse and manifest as systemic and/or localized symptoms. The pathophysiology of SPA is commonly assumed to be autoimmune reaction to seminal plasma with IgE antibodies ; however, it is still uncertain which specific antibodies cause SPA. In vivo skin tests, including prick and intradermal tests, are useful for diagnosing SPA. However, there has been no consensus on treatment of SPA, apart from symptomatic therapy, although several desensitization methods have been reported, using emergency kits for allergic reactions. The most common and most effective preventive measure for SPA is to use condoms during intercourse.

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Background: In home medical care settings, some patients’ families always attend provider visits, and others only do so when needed. The clinical background behind this difference is not well defined.
Methods: A cross-sectional mail survey of families of Japanese patients who had previously received home medical care, asking whether the family had always been present the patient during home healthcare visits and their reasons. Survey results were analyzed with a multivariable adjusted logistic regression model based on the explanatory variables, for aspects related to the family’s attendance at provider visits.
Results: Among the 271 families contacted, 190 families who finally met the selection criteria were divided into two groups : 155 families (81.6%) who had always been present with the patient ; and 35 families (18.4%) who had done so only when needed. Constant attendance by family members was significantly associated with the level of care required (odds ratio [OR] : 1.40, 95% confidence interval [CI] : 1.05–1.89, p = 0.02) and age of the primary caregiver (OR : 1.05, 95% CI : 1.02–1.09, p = 0.03). However, when the family had difficulty communicating with the provider owing to the patient’s presence, families tended not to be present during visits by providers (OR : 0.41, 95% CI : 0.17–1.02, p = 0.06).
Conclusions: In home medical care settings, visiting healthcare providers should bear in mind that if the family is not always present with the patient, there is a possibility that the family is experiencing difficulty communicating with the provider owing to the patient’s presence.

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Background: Little is known about the extent that acute asthma is inappropriately treated with antibiotics in Japanese emergency departments (EDs).Objectives: We examined the proportion and predictors of inappropriate antibiotic use for adults with acute asthma in the Japanese EDs.Methods: We conducted a chart review study in 23 Japanese EDs. Subjects were ED patients aged 18 to 54 years with acute asthma between 2009 and 2011. To examine predictors of inappropriate antibiotic use, we performed multi-level logistic regression analysis at both the patient- and ED-level modeling EDs as a random variable.Results: Among 1380 patients in the overall study, the analytic cohort comprised 1311 patients. Overall, antibiotics were inappropriately prescribed for 4.4% (95% confidence interval [CI], 3.4%–5.7%). In the multi-level logistic regression analysis, higher annual ED asthma visit volume was significantly associated with a lower proportion of inappropriate antibiotic use (odds ratio per 100-visit increase, 0.3 ; 95%CI, 0.2–0.6).Conclusions: In this large multicenter study in Japan, we found that approximately 4% of ED patients with acute asthma were inappropriately treated with antibiotics. We also demonstrated that the inappropriate use of antibiotics largely differed across the EDs and was less common in EDs with a more annual ED asthma visits. Organized knowledge translation initiatives are warranted to address this gap in emergency asthma care.

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Acute aortic dissection (AAD) is a fatal disease and delay in diagnosis results in deteriorated prognosis. A 55-year-old man presented to our hospital with aphasia because of a suspected stroke. Although the lack of pain made diagnosis difficult, we diagnosed Stanford type A AD as the underlying cause of his stroke. Two possible explanations were considered for the lack of pain. First, although the stroke was caused by AD, the stroke itself prevented the patient from feeling the pain. Second, the aphasia prevented him from complaining about the pain. Therefore, we believe that physicians require a high clinical index of suspicion for AD considering the possibility of painless AD or miscommunication secondary to aphasia.

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We report a 42-year-old female who initially complained of sub-acute onset of right upper quadrant abdominal pain with right shoulder pain. A CT scan incidentally revealed an adrenal tumor, and a final diagnosis of pheochromocytoma was made on the basis of endocrinological examinations. Symptomatically, the pheochromocytoma in our patient mimicked a hepato-biliary disease by presenting abdominal pain accompanying right shoulder pain that was assumed to be referred pain via the right phrenic nerve. Physicians may need to consider the possibility of pheochromocytoma in patients with abdominal symptoms.

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The etiology of and optimal treatments for Cronkhite-Canada syndrome (CCS) are still undetermined. Fewer than 5% of CCS patients experience complete remission and 15% of CCS patients develop malignancies. Here, we present a case of CCS involving autoimmune disorders, in which rapid diagnosis, rapid commencement of therapy, and complete remission were achieved after 4 months of prednisolone therapy and polypectomy, although biopsy specimens from all residual colonic polyps revealed adenocarcinoma in one polyp 4 months after prednisolone therapy. It is important to identify gastrointestinal or colonic polyps harboring malignant changes and to examine the involvement of autoimmune mechanisms for better outcomes in CCS patients.

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