In Japan, there were few reports about endoscopy for patients of functional gastrointestinal diseases (FGIDs). First, we studied from clinical data of FGIDs in Yokohama City University. Second, we researched using an original questionnaire for gastroenterologists in university hospital, general hospital and clinics. They performed endoscopy for most of FGIDs. We report this valuable survey with literatures.

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As a psychosomatic treatment for patients with irritable bowel syndrome (IBS), stress management, pharmacotherapy (e. g. antidepressants), and psychotherapy are commonly used. It is considered that psychosomatic treatment plays a major role in treatment guidelines for IBS in Japan. To enhance the effect of psychosomatic treatment for IBS, the development of good patient-doctor relationship and pathophysiology of brain-gut interaction should be taken into account.

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Pathogenesis of functional dyspepsia (FD) is not far from the aspect of psychosomatic medicine. Various disorders of physiological function of the gastrointestinal tract such as gastric acid secretion and motility are associated with pathogenesis of FD. Hence, on the basis of brain-gut-interaction, gastrointestinal physiological functions are also regulated by psychosomatic effects. Clinical guideline of FD was published in 2014 in Japan. It comprehensively reveals the concept, etiology, pathogenesis, and treatment of FD. However, it has not been a complete one, particularly because, the treatment flow chart is not always adapted to every patient with FD. In general, placebo effect is often high in clinical trials of FD treatment. Therefore, efficacy of specific type of drugs or individual drug has not been completely proven by randomized placebo-control studies. Thus, further clinical evidences will be needed for seeking definite therapeutic strategy for FD management.

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Background and aim : Although there are many reports showing the association with stress and gastrointestinal motility disorders, there is no clinical report that evaluates the gastrointestinal motility disorders in the patients with mental disease who had the functional dyspepsia (FD) in many parameters. In the present study, we evaluated the gastrointestinal motility, the degree of the FD symptom, and the degree of depressive and anxiety in the patients with mental disease who had the FD, and we investigated the characteristics of these data. Subjects and methods : We enrolled twenty-three patients with mental disease who had the FD (7 men and 16 women aged from 16y to 78y, the median age is 38y). All patients were diagnosed as having FD according to the Rome III criteria. We used ultrasonographic method to investigate the gastrointestinal motility and evaluated it in four parameters. To evaluate the degree of the major depressive disorder, anxiety disorder, and FD symptom, we used Hospital Anxiety and Depression scale (HADS) and Gastrointestinal Symptom Rating Scale (GSRS). Results : Five subjects were diagnostic of adjustment disorders, 4 of major depressive disorders, 6 of anxiety and panic disorders, 3 of somatoform disorders and, 1 was bipolar disorder, schizophrenia, intellectual development disorder, obsessive-compulsive disorder and eating disorder each. In the examination of gastrointestinal motility disorders, impaired accommodation reflex of the proximal stomach occurred in 12 patients (52.2), delayed gastric emptying occurred in 9 patients (39.1%), motility disorder in antral contractions occurred in 5 patients (21.7%), and increased duodenogastric reflux occurred in 11 patients (47.8%). However we couldn't find the characteristics of these data. Although we could see a positive correction between the degree of FD symptom and the degree of depression and anxiety disorder or the gastric emptying, we could find no correction between the degree of depression and anxiety disorder and the gastric motility. This suggests that the drugs which improve the accommodation reflex of the proximal stomach or reduce duodenogastric reflux may be effective for the patients with mental disease who had the FD.

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Functional gastrointestinal disorders (FGIDs) such as irritable bowel syndrome (IBS) and functional dyspepsia (FD) are disorders of the digestive system in which symptoms cannot be explained by the presence of structural or tissue abnormalities. The Rome diagnostic criteria categorize the FGIDs and define symptom-based diagnostic criteria for each category. Furthermore, the clinical practice guidelines of FGIDs are useful for treatment. The most important issue is to exclude structural or tissue abnormalities that can be seen on endoscopy, radiography, or from blood tests. However, in a diagnosis, serious diseases may be overlooked by downplaying warning symptoms. Even more recently, new diseases which are borderline or indeterminate have been reported in a diagnosis of FGIDs. Moreover, treatment of cases with a strong psychosocial background is difficult for physicians of internal medicine. Close cooperation between physicians of internal medicine and psychotherapists/psychiatrists at an appropriate time is considered important to complement each other in the medical treatment of FGIDs.

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In aged individuals, the morbidity of major depression may confer a worse vital prognosis, and failure to seek medical treatment may result in the disorder becoming chronic. To elucidate the influence of medical treatment-receiving behavior on the one-year outcome, we studied untreated aged individuals with depression who had been identified by a community screening program. The participants in this study were 898 community-dwelling residents of both sexes (in Itabashi Ward, Tokyo) aged 65 to 84 years (first survey conducted in October 2011). Eligibility for entry into the study was determined by reference to a depression-related basic checklist, established by the Ministry of Health, Labour and Welfare. Of the individuals with a positive checklist result, 76 from whom informed consent had been obtained underwent diagnosis by a physician using the Structured Clinical Interview for DSM-IV. Thirteen individuals with major depressive disorder were then identified. A follow-up survey conducted one year later showed that major depressive disorder was still present in seven individuals and partial remission had occurred in two. In 2011, a referral letter to attend a medical institution was sent to all of the subjects diagnosed with major depression. In spite of this, only one individual attended a medical institution during the year, and the one-year outcome in untreated individuals was poor. Even in the one individual in whom therapy was instituted, the result was not adequate because of poor compliance. We thus consider it important not only to support aged individuals who should attend a medical institution, but also to provide continual support to enhance the effect of treatment after attending the institution.

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Objectives : In this study, cognitive function tests were performed on a group of people who were implementing preventive activities for dementia ; the effects of the preventive activities were continuously re-tested and verified. Subjects and Method : A cognitive function test called "Five Cog" was initially administered to the 26 participants before they started their preventive activities. Annual follow-up tests were performed on the participants ; the results of these tests were compared with those of the initial test. Results and Conclusion : As a result, scores on hand locomotion performance, letter recognition verification, associated memory recall, and verbal fluency improved significantly. The study suggested, in addition to increased physical activity, that the active implementation of preventive activities led to an improvement in cognitive functions. The future task is to continue verifying the efficacy of the preventive activities and establish a follow-up system aimed at supporting patients when cognitive decline is discovered.

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We report a case of a patient with isolated ACTH deficiency presenting with non-specific symptoms including fatigability and anorexia. A case was a 65 year-old male. The patient was referred from the Department of Gastrointestinal Medicine to our department for close examination of these chief complaints. The patient was hospitalized on the first visit due to the onset of presyncope induced by hypotension at the initial examination. Adrenocortical insufficiency was suspected because of persistent hypoglycemia during hospitalization and the patient was referred to the Department of Endocrinology and Metabolism. There, the patient was definitely diagnosed as adrenocortical insufficiency secondary to isolated ACTH deficiency. Adrenocortical insufficiency is fatal in some patients and it is difficult to make a definite diagnosis if isolated ACTH deficiency is not considered. Therefore, isolated ACTH deficiency should be suspected in middle-aged and elderly persons who develop malaise, fatigability, weight loss, hypoglycemia, and anorexia without a clear pathology

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