Association of a genetic polymorphism of IL1RN with risk of acute pancreatitis in a Korean ethnic group

BACKGROUND/AIMS: Several epidemiological studies have validated the association of interleukin gene polymorphisms with acute pancreatitis (AP) in different populations. However, there have been few studies in Asian ethnic groups. We aimed to investigate the relationships between inflammatory cytokine polymorphisms and AP as pilot research in a Korean ethnic group. METHODS: Patients who had been diagnosed with AP were prospectively enrolled. DNA was extracted from whole blood, and DNA sequencing was subsequently performed. Single-nucleotide polymorphisms (SNPs) of the interleukin 1β (IL1B), interleukin 1 receptor antagonist (IL1RN), and tumor necrosis factor α (TNFA) genes of patients with AP were compared to those of normal controls. RESULTS: Between January 2011 and January 2013, a total of 65 subjects were enrolled (40 patients with AP vs. 25 healthy controls). One intronic SNP (IL1RN −1129T>C, rs4251961) was significantly associated with the risk of AP (odds ratio, 0.304; 95% confidence interval, 0.095 to 0.967; p = 0.043). However, in our study, AP was not found to be associated with polymorphisms in the promoter regions of inflammatory cytokine genes, including IL1B (−118C>T, c47+242C>T, +3954C/T, and −598T>C) and TNFA (−1211T>C, −1043C>A, −1037C>T, −488G>A, and −418G>A). CONCLUSIONS: IL1RN −1129T>C (rs4251961) genotypes might be associated with a significant increase of AP risk in a Korean ethnic group.

A Case of Choledochocele with Parapapillary Diverticulum Presenting as Pancreatitis / 대한소화기내시경학회지

Choledochocele, classified as choledochal cyst: type III, is a rare cystic or diverticular dilatation of the terminal biliary tree that causes abdominal pain, recurrent pancreatitis, and obstructive jaundice. It is the rarest of the choledochal cysts and has lower malignant potential than any other type of choledochal cyst. Although its anatomic structure does not fit the criteria for pancreatobiliary maljunction, pancreaticobiliary reflux may occur in patients with choledochocele. Herein, we report the case of a 63-year-old woman with recurrent episodes of acute pancreatitis that were caused by a choledochocele with two parapapillary diverticula. She was successfully treated by endoscopic needle-knife sphincterotomy without severe complications and remained asymptomatic at the 6-month follow-up.

A Case of Anomalous Drainage of the Common Bile Duct into the Duodenal Bulb with Pancreatic Duct Anomaly / 대한소화기내시경학회지

The common bile duct normally enters the posteromedial aspect of the second part of the duodenum. However, anomalous drainage of the common bile duct into the stomach, pyloric channel, duodenal bulb and fourth portion of the duodenum has been reported in the literature. An anomalous pancreatic duct, with ectopic drainage of the common bile duct, is particularly rare. Herein, we report the case of a 69-year-old woman who showed pancreatic ductal variation and anomalous drainage of the common bile duct into the duodenal bulb. The patient required a cholecystectomy and choledochoenteric anastomosis to relieve the obstructive jaundice and abdominal pain.

The effect of Helicobacter pylori eradication on the improvement of the symptoms in patients with functional dyspepsia and peptic ulcer disease / 대한내과학회지

BACKGROUND: In the functional dyspepsia, Helicobacter pylori has been suggested as a causative agent. But, the effect of H. pylori eradication is still debated on functional dyspesia. The purpose of this study was to evaluate the effectiveness of the H. pylori eradication therapy in the improvement of the symptoms in patients with functional dyspepsia. METHODS: The convenience sample consisted of 123 patients with functional dyspepsia and 80 patients with peptic ulcer diseases who were infected with H. pylori. All patients had received eradication therapy of H. pylori for one or two weeks and additional therapy with H2RA or PPI for one to five weeks. After the treatment was completed, the patients were asked about their symptomatic improvement every three months. The degree of symptom was rated on a five-point Likert scale. RESULTS: Overall eradication rate of H. pylori was 82.8% (168/203), and there were no significant differences in the eradication rate between the two groups and between one-week and two-week eradication therapies. The mean follow-up period was 12 months. The symptomatic improvement in both group was maintained over 12 months in most patients (PUD 72.5% vs. FD 67.4%). In addition, the symptomatic improvement in the patients with eradication success was maintained significantly longer than those with eradication failure in both group (FD p=0.007 vs. PUD p=0.014). CONCLUSIONS: The eradication therapy of H. pylori can be one of the therapeutic options for patients with functional dyspepsia and that eradication failure may cause the recurrence of the symptom.

Successful Treatment of Multiple Superficial Gastric Antral Bleeding with Alto Shooter(TM) in a Patient with End Stage Renal Disease / 대한소화기내시경학회지

Diffuse or multifocal superficial gastrointestinal bleeding can be treated by endoscopic laser, argon plasma coagulation, heater probe, or electrocoagulation. However, these methods need relatively expensive equipments and clinical experience. Recently, Alto Shooter(TM) (Kaigen Co. Ltd., Osaka, Japan) which can spray 100% sodium alginate was developed to control gastrointestinal bleeding as a topical therapy. We herein present a 47-year-old man with end stage renal disease in whom multiple superficial gastric antral bleeding was successfully managed by the use of Alto Shooter(TM). This method is easy and relatively cheap to use and seems to control superficial bleeding effectively from vascular lesions or after endoscopic biopsy.

A Case of Pneumoretroperitoneum, Pneumomediastinum, and Subcutaneous Emphysema after Endoscopic Sphincterotomy / 대한소화기내시경학회지

Perforation complicates endoscopic sphincterotomy (EST) in approximately 1% of cases. However, pneunomediastinum and/or subcutaneous emphysema due to duodenal perforation after EST have rarely been reported. The management strategy of this awkward complication of EST remains controversial. Conservative treatment with antibiotics and nasogastric and/or biliary drainage has been reported to be adequate, but some authors still advocate early surgery for all perforations. Therefore, it seems necessary to accumulate more data in order to set up a management algorithm in these cases. Recently, we experienced a case of pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema developed after EST and stone removal in which recovery was achieved with conservative treatment in a 87-year-old woman with previous Billroth II partial gastrectomy. We herein report this rare complication of EST and a management algorithm is suggested based on a literature review.

A Case of Intraductal Papillary Mucinous Tumor of the Pancreas Accompanied by Gastric Cancer / 대한소화기내시경학회지

Intraductal papillary mucinous tumor (IPMT) of the pancreas is a distinct entity characterized by intraductal papillary growth and thick mucin secretion. Prolonged postoperative survival can be anticipated in many IPMT cases. However, IPMT of the pancreas was reported to be associated with a high incidence of nonpancreatic neoplasms and these nonpancreatic neoplasms have potential prognostic significance in patients with IPMT. Recently, we experienced a case of IPMT of the pancreas accompanied by gastric cancer in a 72-year-old woman. The main pancreatic duct was incidentally found to be dilated on an abdominal computed tomography performed for staging of gastric cancer. A subtotal gastrectomy and near-total pancreatectomy were carried out. Histopathologic examinations of the resected specimens confirmed the diagnosis of early gastric cancer (T1N1M0) and IPMT of the pancreas, carcinoma in situ, combined type. We report this interesting case with a review of the literature.