A Case of Diffuse Infiltrative Colon Cancer Coexisting with Colonic Tuberculosis / 대한소화기내시경학회지

Inflammatory bowel disease has a potential risk of developing colorectal cancer. However, there is little causal relationship between intestinal tuberculosis and colon cancer because intestinal tuberculosis is curable disease and has relatively short disease course. But there were a few case reports of intestinal tuberculosis associated with colon cancer. Diffuse infiltrating colon cancer, characterized by tumor cells in the presence of inflammatory changes with much fibrosis, is very rare in the colon. We experienced a 49-year-old woman who had tuberculous colitis combined with diffuse infiltrative colon cancer. She visited our hospital because of chronic diarrhea and abdominal pain. Colonoscopy showed multiple geographic ulcers in the transverse colon and partial intestinal obstruction. Histological examination revealed non-caseating granuloma and Mycobacterium tuberculosis was cultured in biopsied tissue. She took an anti-tuberculosis drug for 2 weeks, but her symptoms were aggravated. Therefore, extended right hemicolectomy was performed and revealed mucin-secreting, diffuse infiltrating adenocarcinoma. Herein, we report a rare case of diffuse infiltrative colon cancer coexisting with colonic tuberculosis with a review of liferatures.

The Measurement of Gastric Emptying Time with 3-D Ultrasonography / 대한소화기학회지

BACKGROUND/AIMS: Three dimensional (3-D) ultrasonography is definitely more accurate than conventional 2-D ultrasonography in volume measurement of intra-abdominal organs. However, its application in measuring gastric emptying time has been limited. Thus, we tried to measure gastric antral emptying time by using 3-D ultrasonography and compare with that by radio-scintigraphy. METHODS: We performed both 3-D ultrasonography and radio-scintigraphy on the same day in 23 healthy subjects. After overnight fast, the subjects ingested 500 mL of soup meal (84 Kcal) that had been pre-mixed with 1 mCi of technetium(99m). The half emptying time (T(1/2)) measured by 3-D ultrasonography was defined by the time when the gastric antral volume decreased to half. RESUTLS: The mean T(1/2) of 23 healthy subjects measured by 3-D ultrasonography was 23.4 +/- 10.5 min, while that measured by scintigraphy was 28.4 +/- 14.4 min. The difference (p=0.11 by paired t-test) between the two methods was not significant. Moreover, no significant correlation of T1/2 between the two methods (r=0.361, p=0.09) was observed. CONCLUSIONS: Measuring gastric antral emptying time with 3-D ultrasonography may be useful but require further validation studies and advance in technology.

Eradication Rate of Lansoprazole-Based Triple Therapy in Peptic Ulcer Patients with Helicobacter pylori and Efficacy of Urea Breath Test in Evaluating Helicobater pylori Eradication / 감염과화학요법

BACKGROUND: There are only a few studies on Helicobacter pylori (H. pylori) for its eradication rates of lansoprazole-based triple therapy in Korea, and the results are controversial. Therefore, we undertook to investigate the eradication rate of lansoprazole-based triple therapy, and compare the concordance rate of urea breath test (UBT) and rapid urease test (RUT) in evaluating H. pylori eradication. METHODS: Patients with acute peptic ulcer who were H. pylori-positive were recruited by prospective, consecutive manner. They received lansoprazole 30 mg b.d., amoxicillin 1 g b.d. and clarithromycin 500 mg b.d. for 1 week. Upper endoscopy was performed after 4 weeks to check for ulcer healing, and UBT and RUT were performed to evaluate H. pylori eradication status. RESULTS: A total of 46 patients were recruited, and they were all compliant. H. pylori eradication rate was 87.0% (40/46) and ulcer healing rate was 91.3% (42/46). Forty one patients showed negative in both UBT and RUT, and 4 patients revealed positive in both tests, therefore, the concordance rate of UBT and RUT was 97.8% (45/46). CONCLUSION: Our study showed that 1-week lansoprazole-based triple therapy was effective in H. pylori eradication and ulcer healing. UBT can be an effective, noninvasive method for evaluating H. pylori status after H. pylori eradication.

Eradication Rate of Lansoprazole-Based Triple Therapy in Peptic Ulcer Patients with Helicobacter pylori and Efficacy of Urea Breath Test in Evaluating Helicobater pylori Eradication / 감염과화학요법

BACKGROUND: There are only a few studies on Helicobacter pylori (H. pylori) for its eradication rates of lansoprazole-based triple therapy in Korea, and the results are controversial. Therefore, we undertook to investigate the eradication rate of lansoprazole-based triple therapy, and compare the concordance rate of urea breath test (UBT) and rapid urease test (RUT) in evaluating H. pylori eradication. METHODS: Patients with acute peptic ulcer who were H. pylori-positive were recruited by prospective, consecutive manner. They received lansoprazole 30 mg b.d., amoxicillin 1 g b.d. and clarithromycin 500 mg b.d. for 1 week. Upper endoscopy was performed after 4 weeks to check for ulcer healing, and UBT and RUT were performed to evaluate H. pylori eradication status. RESULTS: A total of 46 patients were recruited, and they were all compliant. H. pylori eradication rate was 87.0% (40/46) and ulcer healing rate was 91.3% (42/46). Forty one patients showed negative in both UBT and RUT, and 4 patients revealed positive in both tests, therefore, the concordance rate of UBT and RUT was 97.8% (45/46). CONCLUSION: Our study showed that 1-week lansoprazole-based triple therapy was effective in H. pylori eradication and ulcer healing. UBT can be an effective, noninvasive method for evaluating H. pylori status after H. pylori eradication.

Effects of Gender and Menstrual Cycle on Colonic Transit Time in Healthy Subjects

BACKGROUND: Measuring colonic transit time (CTT) by the radio-opaque marker method is simple, widely available and important for the diagnosis of slow transit constipation. Moreover, the effects of gender and menstrual cycle on CTT remain controversial. Thus, in this study, we examined the effects of gender and menstrual cycle on CTT in healthy subjects. METHODS: We measured CTT in 42 healthy subjects (21M, 21F) by using a radio-opaque marker, Kolomark (TM). Two simple abdominal radiographs were taken on the 4th and 7th days. Average daily intake of dietary fiber and menstrual history were surveyed. RESULTS: The mean CTT of the 42 healthy subjects was 26.5 +/- 19.4 hours. The mean CTT was not significantly different between the male and female subjects (22.3 +/- 16.1 h vs. 30.1 +/- 21.4 h, p> 0.05). However, the mean CTT of 11 female subjects in the luteal phase was significantly longer than that of 10 female subjects in the follicular phase (40.9 +/- 19.0 h vs. 20.6 +/- 19.2 h, p< 0.05). Serum progesterone level, age, BMI, and the average daily intake of dietary fiber did not correlate with CTT. CONCLUSION: The effects of the menstrual cycle should be considered in interpreting CTT in young women.

A Case of Large Duodenal Ulcer Associated with Candida Albicans / 대한소화기내시경학회지

Candida can be a part of normal human flora, but can be harmful in immunocompromised patients. While oral or esophageal moniliasis can be found in healthy people or gravely ill patients, ulceration of the duodenum is far less common. Acid-reducing drugs such as H2 receptor blocker increase growth of microbes, including fungus, and candidal invasion is regarded as rare one of the factors that are associated with failure to respond to H2 receptor blocker therapy. Recently, we experienced a case of atypical duodenal ulcer which was found in a patient with iatrogenic Cushing's syndrome and diabetes mellitus and failed to respond to H2 receptor blocker therapy. Fungal spores and hyphae were histologically identified from the biopsy specimens that were obtained from the margin of the duodenal ulcer, and this fungus was confirmed as Candida albicans by blood culture. It should be considered that in immunocompromised patients, gastroduodenal ulcers can be caused by fungal infection.

Relationship between Bowel Symptom Changes and Dysmenorrhea in Irritable Bowel Syndrome in Women / 대한소화관운동학회지

BACKGROUND/AIMS: This study was performed to evaluate the relationship between bowel symptom changes and dysmenorrhea in irritable bowel syndrome (IBS) according to the menstrual cycle. METHODS: Two hundred thirty-seven female medical students filled up questionnaires including change of bowel symptom, dysmenorrhea and perimenstrual symptom. Seventeen volunteered to keep diaries concerning their bowel habits and menstruation for two menstrual cycles. RESULTS: One hundred and sixty-three (68.8%) reported that their bowel habit was changed according to menstrual cycle. Ninety-three (39.2%) fit the Rome II criteria of IBS. The number of subjects who reported changed bowel habit during the menstruation period was more in the IBS group than in the non-IBS group (84/93 vs. 83/144, p<0.005). The severity of dysmenorrhea was not different between IBS and non-IBS groups. The menstrual distress score during the menstruation period was significantly higher in the IBS group than in the non-IBS group. In 17 volunteers (12 IBS, 5 non-IBS), stool consistency and frequency were not significantly different between the menstruation and non-menstruation periods, regardless of their IBS status. The mean score of abdominal pain was higher in the menstruation than in the non-menstruation period only in the IBS group. CONCLUSIONS: IBS women have more bowel symptoms during their menstruation period than non-IBS women. Its mechanism should be further clarified.

Clinical Significance of Serum CA 125 in Patients with Chronic Liver Diseases / 대한소화기학회지

BACKGROUND/AIMS: The clinical significance of serum CA 125 levels in patients with chronic liver disease has not been widely appreciated in relation to the severity of the disease. We examined serum CA 125 levels in patients with chronic liver disease according to the severity of liver disease and the presence of ascites. METHODS: Fasting serum CA 125 levels were measured by a commercial RIA kit in 92 patients with chronic liver disease: 22 with chronic hepatitis and 70 with liver cirrhosis (Child class A, 19; B, 28; C, 23). Forty-one patients (45%) had ascites. RESULTS: The patients with Child class C liver cirrhosis had significantly higher mean serum CA 125 level than those with class A (p<0.05). In Child class B patients, the mean serum CA 125 level was significantly higher in patients with ascites than in those without (p<0.05). A multiple regression analysis showed that the presence of ascites, serum albumin, and prothrombin time were independent factors related to the increase of serum CA 125 levels. CONCLUSIONS: The presence of ascites is more closely related to the increase of CA125 levels in patients with liver cirrhosis than the severity of liver disease.

Colonic Transit Time in Diabetic Patients - Comparison with Healthy Subjects and the Effect of Autonomic Neuropathy

Constipation and the use of laxatives are relatively common in patients with diabetes mellitus. However, the mechanisms responsible for the constipation are unclear. Even though autonomic neuropathy is regarded as one of the important mechanisms of constipation, it requires further clarification. In addition, the colonic function in diabetic patients requires further investigation. The aim of this study was to compare the colonic transit time between patients with diabetes mellitus and healthy subjects, and correlate it to the presence of cardiovascular autonomic neuropathy. The colonic transit time was measured by a noninvasive, radio-opaque marker method, and the presence of cardiovascular autonomic neuropathy was evaluated by the beat-to-beat variation and the orthostatic hypotension. Constipation was defined by the Rome II criteria. The mean total colonic transit time of the 28 diabetic patients (34.9 +/- 29.6 h, mean +/- S.D.) was significantly longer than that of the 28 healthy subjects (20.4 +/- 15.6 h, p < 0.05). Among the diabetic patients, 9/28 (32%) had constipation and 14/28 (50%) had cardiovascular autonomic neuropathy. The diabetic patients with constipation showed longer total, left and recto-sigmoid colonic transit times than those without constipation. However, the mean colonic transit time of diabetic patients with and those without cardiovascular autonomic neuropathy was similar. In conclusion, other mechanisms than the mere presence of cardiovascular autonomic neuropathy might be more relevant to the development of constipation in patients with diabetes mellitus.

Noninvasive Measurement of Gastric Accommodation by SPECT

No abstract available.

Clinical Evaluation of Risk Factors in Elderly patients with Reflux Esophagitis / 대한소화관운동학회지

BACKGROUND/AIMS: The elderly patients with reflux esophagitis are less likely to feel or report their symptoms than the younger patients, even though they are more prone to complications such as bleeding, stricture or Barrett's esophagus. In this study we tried to investigate risk factors in the elderly patients who had endoscopically diagnosed reflux esophagitis. METHODS: Clinical data of six hundred and eighty seven patients with reflux esophagitis were reviewed. RESULTS: Among the 687 patients with reflux esophagitis, two hundred and thirteen (31%) were 60 or more than 60 years old. The frequency of accompanying hiatal hernia in the elderly group (age>or=60) was significantly higher than the younger group (age<60) (16.9%, 36/213 vs. 3.4%, 16/474, p<0.05). There was significant difference according age in the female group (0.9%, 1/114 vs. 22.7%, 22/97, p<0.05). The frequency of atropic gastritis was significantly higher in the elderly group than in the younger group , while other factors such as smoking, H. pylori and peptic ulcer disease were not different between the two groups. CONCLUSION: Among the risk factors of reflux esophagitis, the existence of hiatal hernia seems to be suggested more relevant to the development of this condition in the elderly group.

Clinical Evaluation of Risk Factors in Elderly patients with Reflux Esophagitis / 대한소화관운동학회지

BACKGROUND/AIMS: The elderly patients with reflux esophagitis are less likely to feel or report their symptoms than the younger patients, even though they are more prone to complications such as bleeding, stricture or Barrett's esophagus. In this study we tried to investigate risk factors in the elderly patients who had endoscopically diagnosed reflux esophagitis. METHODS: Clinical data of six hundred and eighty seven patients with reflux esophagitis were reviewed. RESULTS: Among the 687 patients with reflux esophagitis, two hundred and thirteen (31%) were 60 or more than 60 years old. The frequency of accompanying hiatal hernia in the elderly group (age>or=60) was significantly higher than the younger group (age<60) (16.9%, 36/213 vs. 3.4%, 16/474, p<0.05). There was significant difference according age in the female group (0.9%, 1/114 vs. 22.7%, 22/97, p<0.05). The frequency of atropic gastritis was significantly higher in the elderly group than in the younger group , while other factors such as smoking, H. pylori and peptic ulcer disease were not different between the two groups. CONCLUSION: Among the risk factors of reflux esophagitis, the existence of hiatal hernia seems to be suggested more relevant to the development of this condition in the elderly group.

Effects of gender and menstrual cycle on colon transit time in healthy volunteers / 대한내과학회지

BACKGROUND: Measuring of colon transit time (CTT) by radiopaque marker is simple, widely available and important for the diagnosis of slow transit constipation. In spite of recently increasing use of a domestically manufactured radiopaque marker, KolomarkTM in Korea, we lack normative data about CTT which can be obtained by KolomarkTM. Moreover, the effect of gender or menstrual cycle on CTT seems to be still controversial. We tried to measure CTT in healthy volunteers and to compare the effect of gender and menstrual cycle on CTT. METHODS: Forty-two healthy volunteers (21 M, 21 F) were recruited through a hospital advertisement. CTT was measured by a KolomarkTM, according to Metcalf's method. Average daily intake of dietary fiber was estimated and menstrual history was acquired from female volunteers whose serum progesterone and estradiole levels were measured by radioimmunoassay. RESULTS: The mean total CTT of 42 healthy volunteers was 26.5+/-19.4 hours. The mean total CTT of male volunteers showed a faster trend than that of female volunteers, however, there was no statistical significance. The mean left CTT was significantly longer in female volunteers than in male volunteers. The mean total CTT of 11 female volunteers in luteal phase (40.9+/-19.0 h) was significantly longer than that of 10 female volunteers in follicular phase (20.6+/-19.2 h, p<0.05). The serum progesterone level, age, BMI and the average daily intake of dietary fiber were not correlated with total CTT. CONCLUSION: Even though total CTT was not significantly different between male and female volunteers, female volunteers in luteal phase showed more prolonged CTT than those in follicular phase.

Analysis of causative agents using biopsy specimens and intraluminal fluid obtained during colonoscopy in patients with acute diarrhea / 대한내과학회지

BACKGROUND: The aim of this study was to investigate the value of colonoscopy for assessment of colonic mucosal lesions and for microbial identification in patients with acute diarrhea. METHODS: From March 2000 to August 2000, forty-one patients with watery or bloody diarrhea lasting less than 15 days were participated after the exclusion of patients who had previous history or presumption of inflammatory bowel disease, radiation colitis, ischemic colitis, or pseudomembranous colitis. Both biopsy specimens and colonic luminal fluid were taken during the colonoscopy and used for bacterial cultures. RESULTS: Male and female ratio was 22:19 and mean age was 45+/-20 years. The extent of acute colitis was as followed: the normal colonoscopic finding in five cases (12.2%), involvement of one segment in 3 cases (7.3%), involvement of two or more segments in 14 cases (34.1%), pancolitis in 10 cases (24.4%) and pancolitis with terminal ileitis in 9 cases (22.0%). In culture study, identification of more than one pathogen was in 19/41 (46.3%) and the common pathogens were Enterobacter (11 cases), Salmonella species (6 cases), Citrobacter freundii complex (2 cases), Klebsiella oxytoca (2 cases) and Morganella morganii (1 case). Pathogen could be identified in 11.8% with stool specimen, 46.2% with biopsy specimen and 62.5% with intraluminal fluid, but without statistical significance. CONCLUSION: Colonoscopy was useful in the evaluation of extent and severity of acute infectious colitis. Obtaining the biopsy specimens and intraluminal fluid during colonoscopy seemed to assist in identifying the pathogen in patients with acute diarrhea.

The comparison of histologic gastritis in patients with duodenal ulcer, chronic gastritis, gastric ulcer and gastric cancer

This study was designed to investigate the differences of histologic gastritis according to the endoscopic diagnosis, and between H. pylori positive and negative gastritis, using the Sydney system. A total of 122 patients (42 duodenal ulcer, 31 chronic gastritis, 35 gastric ulcer and 14 gastric cancer) underwent endoscopy with biopsies from the antrum and body. Among the 122 patients, 104 (85%) were H. pylori positive. H. pylori density of the antrum was significantly higher in duodenal ulcer than in chronic gastritis, gastric ulcer, and gastric cancer. The positivity of intestinal metaplasia was lowest in duodenal ulcer and highest in gastric cancer. H. pylori density as well as grade of activity, inflammation and atrophy were significantly higher in the antrum than in the body in duodenal ulcer, while in chronic gastritis, gastric ulcer and gastric cancer there was no difference of H. pylori density, activity, inflammation and atrophy between the antrum and body. The grade of activity and chronic inflammation were significantly higher in H. pylori positive patients than in H. pylori negative patients in both the antrum and body. In conclusion, the gastritis of duodenal ulcer was mainly localized to the antrum, while the gastritis of chronic gastritis, gastric ulcer or gastric cancer was rather uniform in the antrum and body. H. pylori seemed to be related to the development of chronic inflammation and activity.

TProtective effect of chlormethiazole, a sedative, against acetaminophen-induced liver injury in mice

OBJECTIVES: The hepatotoxicity of acetaminophen is not a result of the parent compound but is mediated by its reactive metabolite N-acetyl-p-benzoquinone imine. Cytochrome P4502E1 (CYP2E1) is the principal enzyme of this biotransformation, which accounts for approximately 52% of the bioactivation in human microsomes. Recently, chlormethiazole a sedative drug, is reported to be an efficient inhibitor of CYP2E1 activity in human beings. In this study we wished to evaluate whether chlormethiazole, an inhibitor of CYP2E1, could prevent acetaminophen-induced liver injury in mice. METHODS: Acetaminophen, at doses ranging from 200 to 600 mg/kg, was injected into the peritoneum of female C57BL/6 inbred mice fasted for four hours. Chlormethiazole (60 mg/kg) or 5% dextrose water was given 30 min before or 2 h after acetaminophen. Serum aminotransferase activities, histologic index score, survival rate and hepatic malondialdehyde levels were compared. RESULTS: Pretreatment with chlormethiazole 30 min before 400 mg/kg of acetaminophen completely inhibited acetaminophen-induced liver injury (median 118.5 U/L, range 75 to 142 vs. 14,070 U/L, range 5980 to 27,680 for AST; 49 U/L, range 41 to 64 vs. 15,330 U/L, range 13,920 to 15,940 for ALT). In mice receiving chlormethiazole 2 h after acetaminophen, the mean AST and ALT levels were also less elevated, reaching only 20% of the value of acetaminophen-only group. These protective effects were confirmed histologically. Whereas more than 50% of mice died at 500 mg/kg of acetaminophen, all the mice pretreated with chlormethiazole survived at the same dose. CONCLUSION: Chlormethiazole effectively reduces acetaminophen-induced liver injury in mice. Further studies are needed to assess its role in humans.

The Role of the Helicobacter pylori CagA Gene in Gastric Cancer Tissue of Koreans / 대한소화기내시경학회지

BACKGROUND AND AIMS: To further understand the relationship between the cagA gene and gastric cancer, the positive rates of the cagA gene in cancer and non-cancer tissues were investigated separately in patients with gastric cancer. METHODS: The cagA gene was detected by PCR and the ureC gene was analyzed as a positive control for the presence of Helicobacter pylori. Each of two endoscopic biopsies were obtained from cancer and non-cancer tissues of 41 patients with gastric cancer. RESULTS: 1) The positive rate of the cagA gene in cancer tissues was 29.3% (12/41), which was significantly lower than that in non-cancer tissues (63.4%). 2) Twelve (29.3%) out of 41 were positive for the cagA gene in both cancer and non-cancer tissues, 14 were positive in only non-cancer tissues, none were positive in only cancer tissues, and 15 (36.6%) were negative in both sites. 3) The ureC gene was negative in cancer tissue in 12 (85.7%) among 14 cases who were cagA gene negative in the cancer tissue but positive in the non-cancer tissue. 4) There was no difference in the positive rate of the cagA gene according to age, stage, site, and pathologic cell type. CONCLUSIONS: These findings indicate that the positive rate of the cagA gene in cancer tissue was lower than that in non-cancer tissues and this might be related to a low infection rate of H. pylori in cancer tissue rather than the presence of cagA negative H. pylori in cancer tissues.

The mechanism of antiproliferative effect of desferrioxamine on human hepatoma cell lines

We investigated the effect of desferrioxamine (DFO), an iron chelator, on the DNA synthesis and the cell cycle of cultured hepatoma cells. Using Hep 3B cells as the hepatoma cell lines, DNA synthesis was measured by [3H] thymidine incorporation, and the cell cycle analysis was performed by flow cytometry including bivariate DNA/BrdU analysis. [3H] thymidine uptake was decreased by DFO in a dose dependent manner. The proportion of S phase cells increased and that of G0/G1 phase cells decreased after the addition of DFO in the culture media in a dose dependent manner up to 20 micrograms/ml of DFO. The S phase duration of the exponentially proliferating Hep 3B cells was 9.9 hours when cultured without DFO, but it was markedly prolonged (54.1 hours) after the addition of 20 micrograms/ml of DFO. After removal of DFO from the culture media following 24 hours of incubation with 20 micrograms/ml of DFO, a sequential increase from early through mid and late-S to G2/M phase was observed. In conclusion, the antiproliferative effect of DFO on cultured human hepatoma cell lines was caused by the inhibition of DNA synthesis which was related to a block in the early-mid S interface or mid S phase of the cell cycle.

Aplastic Anemia Associated with Stomach

Herein is presented a case of aplastic anemia associated with adenocarcinoma of the stomach which seem- ed to be coincidental. A 52 year-old man was admitted with a 3 year history of dyspnea. Three years previously, he was diagnosed as bone marrow hypoplasia and had been treated with oxymetholone for 1 year. After confirmation of aplastic anemia during the first admission, he was followed up with fluoxymesterone and steriods. One year later, he was readmitted with melena. Fibergastroscopy and an UGl study revealed a fungating mass on the antrum suggestive of stomach cancer. Following perioperative platelet transfusions and intensive supportive care, a subtotal gastrectomy was performed and there were no postoperative complications. Pathologic examinations disclosed a moderately well differentiated adenocarcinoma. This is the first report in Korea of adenocarcinoma of the stomach occurring in a patient with aplastic anemia. He survived 17.5 months after the surgery and 5.4 years after the onset of aplastic anemia. Gastrointestinal bleeding in aplastic anemia may be incorrectly ascribed to steriod use and overlooked, thus the need to fully investigate gastric pathology by endoscopy as well as radiology is streesed. In a patient with pancytopenia, the major surgical procedures are frequently evaded by both surgeons and internists due to the possibility of morbidity from bleeding and infection. In this case, intensive perioperative supportive care and surgery were combined to prolong the patient's survival time.