Clinical Distinct Features of Noncardiac Chest Pain in Young Patients

BACKGROUND/AIMS: Noncardiac chest pain (NCCP) is a very common disorder world-wide and gastroesophageal reflux disease (GERD) is known to be the most common cause. The prevalence of NCCP may tend to decrease with increasing age. However, there is little report about young aged NCCP. The aim of this study was to examine the prevalence of GERD and to evaluate the efficacy of proton pump inhibitor (PPI) test in the young NCCP patients. METHODS: Thirty patients with at least weekly NCCP less than 40 years were enrolled. The baseline symptoms were assessed using a daily symptom diary for 14 days. Esophago-gastro-duodenoscopy (EGD) and 24 hr esophageal pH monitoring were performed for the diagnosis of GERD and esophageal manometry was done. Then, patients were tried with lansoprazole 30 mg twice daily for 14 days, considering positive if a symptom score improved > or = 50% compared to the baseline. RESULTS: Nine (30%) of the patients were diagnosed with GERD at EGD and/or 24 hr esophageal pH monitoring, also, 3 (10%) were diagnosed with GERD-associated esophageal motility disorder and 3 (10%) were non GERD-associated. Concerning PPI test, GERD-related NCCP had a higher positive PPI test (n = 8, 89%) than non GERD-related NCCP (n = 5, 24%) (p = 0.002). CONCLUSIONS: In young patients with NCCP, a prevalence of GERD diagnosed using EGD and/or 24 hr esophageal pH monitoring was 30%. PPI test was very predictable on diagnosis of GERD-related NCCP, thus, PPI test in young NCCP patients may assist to the physician's clinical judgment of NCCP.

Clinical Validity of 13C - Urea Breath Test for the Diagnosis of Helicobacter pylori Infection: A Multi-Center, Open, and Noncomparative Trial / 대한내과학회지

OBJECTIVE: Helicobacter pylori(H. pylori) infection plays an importanat role in the pathophysiology of gastrointestinal diseases, and its diagnosis is crucial in clinical practice. Currently many diagnostic methods are introduced for its simple, and accurate diagnosis. 13C urea breath test(13C-UBT) is a convenient, non-invasive and reliable test for the diagnosis of H. pylori infection. To assess the clinical value of the 13C-UBT, we examined the sensitivity, specificity of 13C-UBT with regard to other tests. METHODS: A prospective multicenter study was done in 107 subjects(mean age 36 years, 55 males, 52 females) presenting for endoscopy from three university hospitals. We tested for H. pylori infection by 13C-UBT, serum IgG antibody level, and multiple biopsies for rapid urease testing and histology. Either a positive histology result or a combined positive CLO test and IgG ELISA in the presence of a negative histology results, was interpreted as a positive finding for H. pylori infection. 13C-UBT was performed after 4hrs fast. Breath samples were collected at 0 and 30 minutes after giving 75mg 13C-urea. RESULTS: Results were analysed by isotope ratio mass spectrometry and expressed as units of delta( 13C, 13CO2 /12CO2) and considered as positive for H. pylori if delta value was greater than 4.0. Sensitivity and specificity of 13C-UBT were 94.5%, and 100% respectively. No significant adverse events were noted. CONCLUSIONS: The 13C-UBT offers an easy, safe and accurate approach to the diagnosis of H. pylori infection in routine clinical practice

Cystic Lesions in the Stomach

Cystic lesions of the stomach are rare and usually detected incidentally during surgery or autopsy. Amongseven cases of cystic masses, duplication cysts accounted for four, retension cysts of ectopic pancreas for two,and cystic lymphangioma remaining one. In the upper gastrointestinal series, all were submucosally, whileendoscopic ultrasonography showed that the location of cystic masses was also submucosal. Except for two cases ofduplication cyst and cystic lymphangioma which were thin-walled, lesions were well-defined and showed lowattenuation. In addition, abdominal CT scanning showed two cases of retension cyst of ectopic pancreas.