Incidence, Morbidity, and Mortality of Achalasia: A Nationwide, Population-Based Cohort Study in South Korea

Background/Aims@#Although an association between achalasia and esophageal cancer has been reported, whether achalasia confers a substantial increase in mortality is unknown. Moreover, the causes of death related to achalasia have not been investigated. We performed this nationwide, population-based cohort study on achalasia because no such study has been performed since the introduction of high-resolution manometry in 2008. @*Methods@#This study was performed using data extracted from the Korean National Health Insurance Service database, covering a 9-year period from 2009 to 2017. Control participants without a diagnostic code for achalasia were randomly selected and matched by sex and birth year at a case-to-control ratio of 1:4. Data on the cause of death from Statistics Korea were also analyzed. @*Results@#The overall incidence of achalasia was 0.68 per 100,000 person-years, and the prevalence was 6.46 per 100,000 population. Patients with achalasia (n=3,063) had significantly higher adjusted hazard ratio (aHR) for esophageal cancer (aHR, 3.40; 95% confidence interval [CI], 1.25 to 9.22; p=0.017), pneumonia (aHR, 2.30; 95% CI, 1.89 to 2.81; p<0.001), aspiration pneumonia (aHR, 3.92; 95% CI, 2.38 to 6.48; p<0.001), and mortality (aHR, 1.68; 95% CI, 1.44 to 1.94; p<0.001). Esophageal cancer carried the highest mortality risk (aHR, 8.82; 95% CI, 2.35 to 33.16; p=0.001), while pneumonia had the highest non-cancer mortality risk (aHR, 2.28; 95% CI, 1.31 to 3.96; p=0.004). @*Conclusions@#In this nationwide study, achalasia was associated with increased risk of mortality.Esophageal cancer and pneumonia were the most common comorbidities and the major causes of death in patients with achalasia.

Recent Trends in Tailored Treatments for Helicobacter pylori Infection

The efficacy of the standard triple eradication regimen for Helicobacter pylori (H. pylori) infection is gradually decreasing due to increased antibiotic resistance of H. pylori, which is represented by clarithromycin resistance. This is an important issue for clinicians. Tailored therapies for H. pylori infection, including culture-based susceptibility testing and molecular methods detecting genetic mutations that increase resistance to antibiotics, have been introduced to overcome the high treatment failure rate of the standard triple regimen. The treatment results have been satisfactory. In addition to the H. pylori-related factors, the CYP2C19 gene polymorphism, in terms of host factors, affects the effectiveness of proton pump inhibitors. This article reviews the status of the tailored therapies for H. pylori infection along with the proven therapeutic effects and benefits of such treatments in Korea, where the resistance to antibiotics such as clarithromycin, metronidazole, and quinolone is prevalent.

Recent Trends in Tailored Treatments for Helicobacter pylori Infection

The efficacy of the standard triple eradication regimen for Helicobacter pylori (H. pylori) infection is gradually decreasing due to increased antibiotic resistance of H. pylori, which is represented by clarithromycin resistance. This is an important issue for clinicians. Tailored therapies for H. pylori infection, including culture-based susceptibility testing and molecular methods detecting genetic mutations that increase resistance to antibiotics, have been introduced to overcome the high treatment failure rate of the standard triple regimen. The treatment results have been satisfactory. In addition to the H. pylori-related factors, the CYP2C19 gene polymorphism, in terms of host factors, affects the effectiveness of proton pump inhibitors. This article reviews the status of the tailored therapies for H. pylori infection along with the proven therapeutic effects and benefits of such treatments in Korea, where the resistance to antibiotics such as clarithromycin, metronidazole, and quinolone is prevalent.

Sarcopenia is associated with severe erectile dysfunction in older adults: a population-based cohort study

Background/Aims@#Sarcopenia and erectile dysfunction (ED) are associated withpoor health and quality of life in older men. We investigate the association betweensarcopenia and severe ED in community-dwelling older men. @*Methods@#We prospectively assessed sarcopenia and ED in 519, community-dwelling, older men (mean age, 74.0) in Pyeongchang, Korea, in 2016 to 2017. Sarcopenia was based on muscle mass, grip strength, and gait speed according to the Asian Working Group consensus algorithm. Severe ED was defined as 5-item International Index of Erectile Function questionnaire score under 8. Logistic regressions were used to study associations between incident severe ED and sarcopenia, after adjusting age, cardiovascular risk factors, depression, and polypharmacy. @*Results@#The prevalence of severe ED was 52.4% and that of sarcopenia was 31.6%.At baseline, the prevalence of severe ED was higher in men with sarcopenia than in those without (73.2% vs. 42.8%; adjusted odds ratio [aOR], 1.89; 95% confidence interval [CI], 1.18 to 3.03; p = 0.008). Slow gait speed (aOR, 2.80; 95% CI, 1.18 to 6.62;p = 0.019) and decreased muscle mass (aOR, 2.54; 95% CI, 1.11 to 5.81; p = 0.027) were associated with the incidence of severe ED, while decreased grip strength (aOR, 0.76; 95% CI, 0.30 to 1.91;p = 0.564) was not. @*Conclusions@#Sarcopenia was associated with severe ED. Slow gait speed, and decreased muscle mass was independently associated with incident severe ED at 1 year. Further research is warranted to examine whether an intervention targeting these components can prevent severe ED.

Helicobacter pylori Eradication Therapy Is Effective as the Initial Treatment for Patients with H. pylori-Negative and Disseminated Gastric Mucosa-Associated Lymphoid Tissue Lymphoma

BACKGROUND/AIMS: We investigated the effectiveness of Helicobacter pylori eradication therapy for gastric mucosa-associated lymphoid tissue (MALT) lymphoma regardless of the H. pylori infection status or disease stage. METHODS: From November 1995 to September 2014, 345 subjects who were diagnosed with gastric MALT lymphoma and had received eradication therapy as their first-line treatment were eligible for inclusion in this study. A retrospective review was performed using the medical records. RESULTS: Of the 345 patients, H. pylori infection was detected in 317 patients (91.9%). The complete remission (CR) rate after eradication therapy was 82.3%, which was higher in H. pylori-positive patients than in H. pylori-negative patients (84.5% vs 57.1%, p=0.001). CR rates after eradication did not present significant differences between stages, and the CR rate was 83.3% for stage IE1 and 74.4% for stage IE2 or above (p=0.167). The overall CR rate was 87.2% after additional treatment, and neither H. pylori infection status nor stage showed differences according to the treatment response. CONCLUSIONS: Eradication therapy led to CR in 57.1% of H. pylori-negative patients and in 74.4% of patients with stage IE2 or above. Eradication therapy is worthwhile as an initial treatment for gastric MALT lymphoma regardless of the H. pylori infection status and stage.

Bronchiolitis Obliterans Associated with Stevens-Johnson Syndrome: A Case Report

We report a case of bronchiolitis obliterans associated with Stevens-Johnson syndrome. A 59-year-old man presented with respiratory distress that gradually worsened over 3 months. He had been diagnosed with Stevens-Johnson syndrome 3 months before admission. He had no history of previous airway disease. On physical examination, expiratory breathing sounds were not audible, and a chest X-ray revealed a hyperinflated lung. A pulmonary function test indicated a severe obstructive pattern. Computed tomography scans of inspiratory and expiratory phases of respiration showed oligemia and air trapping, and both were more prominent on expiration view than on inspiration view. The pathogenesis of bronchiolitis obliterans associated with Stevens-Johnson syndrome is largely unknown.

A Case of Disseminated Cryptococcosis Mimicking Lung Cancer and Prostate Cancer in an Immunocompetent Patient: A Review of the Literature / 대한내과학회지

Cryptococcosis can occur in immunocompetent patients; in fact, it accounts for 20% of all cryptococcal infections. In immunocompetent patients, although clinical symptoms may not be obvious, cryptococcosis should be considered in the differential diagnosis for cancer and other diseases. We recently encountered a case of disseminated cryptococcosis involving the lung and prostate. A 71-year-old male patient was referred for evaluation of a large pleural effusion. He was a 40 pack-years ex-smoker, and showed no evidence of immunodeficiency. Chest computed tomography and positron emission tomography images suggested primary lung cancer with pleural metastases and prostate cancer. Tuberculous pleurisy was suspected due to a lymphocyte-dominant exudative pleural effusion and high level of adenosine deaminase. Prostate and bronchoscopic biopsies demonstrated chronic granulomatous inflammation, and periodic acid Schiff's and Grocott's methenamine silver staining confirmed cryptococcosis in both specimens. Antifungal therapy with fluconazole was started, and follow-up images showed complete resolution of the pleural effusion.

Potentially Inappropriate Medications in Elderly Outpatients by the 2012 Version of Beers Criteria: A Single Tertiary Medical Center Experience in South Korea

BACKGROUND: The American Geriatric Society released the 2012 updated version of the Beers criteria with intentions to improve care of older adults by reducing their exposure to potentially inappropriate medications (PIMs). However, there have been no reports on the prevalence of PIMs prescriptions according to the 2012 version of Beers criteria in South Korea. METHODS: This is a retrospective study using medical records and code analysis of each PIM to survey the prevalence of PIMs prescriptions and common PIMs used for elderly patients. Locating the PIMs was carried out in all outpatients who visited Asan Medical Center from May 2012 to April 2013. Selection of PIMs was based on the 2012 updated version of the Beers criteria. RESULTS: A total of 652,192 outpatients older than 65 years visited our medical center during the study period and were analyzed. Among them, 33,810 (5.19%) received at least one PIM and 125,498 cases of PIM prescriptions were written. The percentage of the patients who received at least two kinds of PIMs concurrently was 33.14%. Common PIMs were tramadol (24.15%), clonazepam(11.51%), ibuprofen (10.02%), megesterol (9.80%), and amitriptyline (9.51%). CONCLUSION: Our study investigated the prevalence of PIMs prescription for Korean elderly outpatients in a single tertiary medical center. Compared to previous reports using the older version of the Beers criteria, our study showed a change in the priority of common PIMs.