Clinical Features of Acute Hepatitis A in the Western Part of Daejeon and Chungnam Province: Single Center Experience / 대한소화기학회지

BACKGROUND/AIMS: There was an outbreak of hepatitis A in the western part of Daejeon with adjacent Chungnam province in the late 1990's. The aim of this study was to characterize the clinical features and courses of acute hepatitis A in this area. METHODS: A total of 177 cases, who were diagnosed as acute hepatitis A between June 2000 and December 2004, were reviewed retrospectively. CONCLUSIONS: The mean age was 26 and 96% of the cases were under 40 years old. The ratio of male to female was 1.2:1. There were two hospitalized cases in 2000, 3 in 2001, 73 in 2002, 60 in 2003, and 39 in 2004, respectively. The number of diagnosis was most prevalent in June (20.3%). Common occupations were students (62 cases) and homekeepers (21 cases). It was found that 51 patients experienced consumption history of raw fish or shellfish, and that 18 cases had history of exposure to contaminated underground water. Eighteen cases were infected by family members or friends. A history of travel to domestic areas was noted in 31 cases, and to overseas areas in 6 cases (especially Southeast Asia). Only four cases were vaccinated against hepatitis A. HBsAg was positive in 10 cases, and anti-HCV in 2 cases, but none of these had active diseases. The common symptoms were anorexia, jaundice and fatigue. The common ultrasonographic findings were fatty liver (68/157) and acute hepatitis (39/157). In most cases, ALT and total bilirubin level normalized within 8 weeks. No cases of fulminant hepatitis or death were observed. CONCLUSIONS: The majority of cases with acute hepatitis A were completely recovered without sequelae. It is necessary to investigate specific indications for hepatitis A vaccination either in this area or throughout Korea.

The Comparison of Sizes Measured by Esophagogastroduodenoscopy and Endoscopic Ultrasonography in Small Submucosal Tumors / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic ultrsonography (EUS) can provide detailed information about submucosal tumors such as size, echo pattern, wall of origin and relation to adjacent organs. However, EUS is not a cost effectiveness and time-consuming procedure and many patients experience discomfort during the procedure. We tried to verify the usefulness of Esophagogastroduodenoscopy (EGD) in the measurement of submucosal tumor size in comparison with EUS. METHODS: We compare the size of small submucosal tumors from 68 patients measured by EGD and EUS at Konyang University Hospital from year 2000 to 2003. RESULTS: Most of submucosal tumors were located in muscularis propria layer. The size of submucosal tumor measured by gastroscopy correlated well with the size by EUS (r=0.91). Submucosal tumor measured by EGD was slightly larger than EUS measurement (p=0.008). CONCLUSIONS: The size of submucosal tumors measured by EGD was slightly larger than that by EUS due to covering mucosa, but both sizes were linearly correlated. So we think that gastroscopy plays as one strategy for the surveillance or follow-up procedure of small sized submucosal tumors which do not exhibit the suspicion of malignant potential.

A Case of Acute Phlegmonous Gastritis Treated with Antibiotics Alone / 대한소화기내시경학회지

Acute phlegmonous gastritis is a rare disorder in which bacterial infection occurs in the gastric wall. Gastrectomy involving the affected area has been thought to be an effective form of treatment. The mortality rate remains extremely high despite therapy with antibiotics. The authors report a case of a 59-year-old man who had severe abdominal pain with signs of peritonitis. Endoscopy showed edematous and thickened mucosal fold with narrow lumen and yellow, whitish exudate-like materials on mucosal surface in the whole stomach. Gastric juice culture revealed the growth of Enterococcus faecalis. Contrast-enhanced CT scan of abdomen showed diffuse extensive mural thickening with hypodense area from the fundus to the antrum. The lumen was narrowed, but there was no gastric outlet obstruction. There was marked thickening of gastric wall (submucosal layer) on EUS examination. Through early diagnosis without laparotomy, the patient was successfully treated with antibiotics alone without complication.

Endoscopic Removal of Foreign Bodies in the Upper Gastrointestinal Tract / 대한소화기내시경학회지

BACKGROUND/AIMS: Foreign bodies in the upper gastrointestinal tract are produced chiefly by accidental swallowing, but rarely produce symptoms. Although most foreign bodies pass spontaneously, 10~20% of those need treatment. We evaluated the role of endoscopy for removal of foreign bodies in the upper gastrointestinal tract. METHODS: We retrospectively reviewed 80 cases of foreign bodies in the upper gastrointestinal tract who had been treated using endoscopy at Konyang University Hospital from February 2000 to July 2003. RESULTS: The age ranged from 14 months to 75 years (mean 36.8 years-old). Patients over 60 years, under 10 years were 20 cases and 28 cases, respectively and male to female ratio was 1.1:1. Common foreign bodies are coin (20 cases), fishbone (12 cases), animal bone (11 cases) and meat stuff (9 cases). The most common location was the esophagus (68.8%). In most cases (88.8%), foreign bodies were removed using alligator tooth forceps. Fourteen patients had co-morbidities such as esophageal diseases, psychiatric disorders, diabetes mellitus, hypertension, stomach cancer, and subtotal gastrectomy. CONCLUSIONS: Endoscopy is a useful tool for removal of foreign bodies in the upper gastrointestinal tract.