Role of Stress in Functional Dyspepsia / 대한소화관운동학회지

BACKGROUND/AIMS: Pathogenesis of functional dyspepsia consists of motor abnormality, sensory abnormality, and psychologic abnormality. Anxiety, depression, and psychosomatic disorders are well known psychopathologies that lead to dyspepsia, and stress seems to be an additional etiology. The aim of this study is to assess whether stress can cause and/or provoke dyspepsia. METHODS: Functional dyspepsia was defined and classified by Rome criteria. SCL-90-R for the detection of psychopathology, measurement of life stress scale by self-administered questionnaire, and measurement of stress coping mechanisms using a multidimensional stress coping scale test were performed in 79 functional dyspeptic patients and 25 normal controls. RESULTS: No significant difference was found in the total amount of stress between functional dyspeptic patients and the normal control. However, the patients were more stressful about issues relating to health and marital relationship among stresses in individual daily life. As the patients become more stressful, they used more negative coping mechanisms such as restraint, fatalism, criticism, religiousness, and negativism. These seem to provoke several psychopathologies including interpersonal sensitivity, depression, anxiety, hostility. However, there was no relationship in the amount of stress, the stress coping mechanism, and psychopathology among the dyspeptic symptoms and subgroups of functional dyspepsia. CONCLUSION: There was no difference in the total amount of stress between functional dyspeptic patients and the normal control. In some individuals who utilize inadequate coping mechanisms against stress, the stress can provoke dyspepsia.

Role of Stress in Functional Dyspepsia / 대한소화관운동학회지

BACKGROUND/AIMS: Pathogenesis of functional dyspepsia consists of motor abnormality, sensory abnormality, and psychologic abnormality. Anxiety, depression, and psychosomatic disorders are well known psychopathologies that lead to dyspepsia, and stress seems to be an additional etiology. The aim of this study is to assess whether stress can cause and/or provoke dyspepsia. METHODS: Functional dyspepsia was defined and classified by Rome criteria. SCL-90-R for the detection of psychopathology, measurement of life stress scale by self-administered questionnaire, and measurement of stress coping mechanisms using a multidimensional stress coping scale test were performed in 79 functional dyspeptic patients and 25 normal controls. RESULTS: No significant difference was found in the total amount of stress between functional dyspeptic patients and the normal control. However, the patients were more stressful about issues relating to health and marital relationship among stresses in individual daily life. As the patients become more stressful, they used more negative coping mechanisms such as restraint, fatalism, criticism, religiousness, and negativism. These seem to provoke several psychopathologies including interpersonal sensitivity, depression, anxiety, hostility. However, there was no relationship in the amount of stress, the stress coping mechanism, and psychopathology among the dyspeptic symptoms and subgroups of functional dyspepsia. CONCLUSION: There was no difference in the total amount of stress between functional dyspeptic patients and the normal control. In some individuals who utilize inadequate coping mechanisms against stress, the stress can provoke dyspepsia.

A case of small cell carcinoma of the rectum manifesting as pathologic femur neck fracture / 대한내과학회지

Small cell carcinoma of the colon and rectum is a rare primary epithelial malignancy at this location. Histologically, this tumor represents a spectrum of neuroendocrine differentiation. The neuroendocrine cancers of the colon manifest a highly aggressive behavior, even more than their adenocarcinoma counterpart of the same stage. Small cell carcinoma in the colon has early metastasis and the prognosis is extremely poor. We report a case of small cell carcinoma of the rectum manifesting as femur neck fracture during sleep.

Prevalence of gastroesophageal reflux in routine check-up subjects / 대한내과학회지

BACKGROUND: Gastroesophageal reflux disease (GERD) is considered to be less common in the Orient compared to the West, but epidemiological data on GERD in Korea are rare. The aim of this study was to determine the prevalence of symptoms of gastroesophageal reflux in routine check-up subjects. METHODS: We analyzed 2243 subjects (male 716, female 1527; age range 20-69 yr) visited health promotion center for routine check-up. Subjects were given a validated self-reported questionnaire, which measured the presence, duration and severity of typical symptoms (heartburn, acid regurgitation); and the presence of atypical symptoms. At least weekly symptoms of heartburn and/or acid regurgitation were characterized as the definition of GERD. RESULTS: The prevalence of heartburn for at least monthly, at least weekly and at least daily episodes was 6.2%, 3.4% and 3.1%, respectively. The corresponding figures for acid regurgitation were 6.1%, 2.1% and 0.7%. The prevalence of GERD was 8.5%, and was more common in female (p< 0.01). Sixty eight percent of subjects with GERD reported the symptoms as having been present for less than 5 years. Seventy four percent of subjects with GERD reported these symptoms to be mild to moderate in severity. Heartburn and acid regurgitation were significantly associated with dyspepsia, chest pain, dysphagia and globus sensation (p< 0.01), but not with hoarseness or chronic cough. CONCLUSION: The prevalence of heartburn and/or acid regurgitation experienced at least weekly is 8.5% in routine check-up subjects. Heartburn and acid regurgitation were associated with epigastric pain, chest pain, dysphagia and globus sensation.

Bowel habits in routine check-up subjects / 대한내과학회지

BACKGROUND: To estimate bowel patterns in the Korean, we surveyed routine check-up subjects about their bowel habits, using self-reported questionnaire. METHODS: We analyzed 2939 subjects (male 1430, female 1509; age range 25 - 65 years) who had visited health promotion center for routine check-up. Subjects were given a validated self-report questionnaire, which measured the defecation frequency; stool consistency; self-report of constipation; straining to defecate; and levels of laxative use. RESULTS: Of the whole subjects 96.4% had defecation frequency between three per week and three per day. The prevalence of two or less bowel movements per week (4.1% compared to 0.6%), straining to defecate (20.8% compared to 13.0%) and hard stool (18.0% compared to 9.3%) was higher in women than men (p<0.01). The prevalence of self-reported constipation was higher in women than men (9.0% compared to 2.9%, p<0.01). Women were more likely to use laxatives than men (5.5% compared to 0.6%, p<0.01). CONCLUSIONS: Defecation frequency in most of routine check-up subjects is between three per week to three per day. Bowel dysfunction is a greater problem in women.

The Prevalence and Characteristics of Colorectal Polyps found by Sigmoidoscopy in Asymptomatic Korean Adults / 대한내과학회지

OBJECTIVES: Colorectal polyps play an integral role in the development of colon cancer. The prevalence of colorectal polyps in Korea was reported to be 5-12%. However, these results were obtained from retrospective studies, in which the subjects were symptomatic patients. Therefore, we performed a prospective study in asymptomatic Korean adults to determine the prevalence, characteristics, and risk factors of colorectal polyps. METHODS: Flexible sigmoidoscopy was done during the period between August 1994 to November 1995 in 2,985 aymptomatic individuals who visited Samsung Medical Center for health check-ups. RESULTS: 1) Polyps were found in 590 subjects (20.4%) out of 2,985 individuals. The prevalence rate increased with age. 2) In histologic findings of colorectal polyps, there were 369 cases (45.8%) of adenomatous polyps, 245 cases (30.4%) of hyperplastic polyps and 5 cases of carcinomas. 3) Moderate to severe dysplasia was found in 15.4% of adenomatous polyps and the grade of dysplasia increased with polyp size. 4) The prevalence rate of polyps increased according to obesity, blood cholesterol and triglyceride level, the frequency of alcohol consumption and the amount of smoking in cases. Conclusions : Screening by sigmoidoscopy is considered to be beneficial for detection of colorectal polyps in asymptomatic Korean adults, especially in individuals with risk factors such as obesity, heavy smoking and alcohol consumption.

Esophagus, Stomach & Intestine; A Case of the Cervical Carcinoma Involving the Second Portion of the Duodenum / 대한소화기내시경학회지

In Korea, careinoma of the cervix is the most common malignancy in women annually affecting 25 per every 100,000 female. The widespread use of the Papanicolaou smear has resulted in earlier detection of the tumor and a reduction in the number of patients with advanced disease, but the incidence of cervix. carcinoma is still the fifth most common malignancy in the world. Cervical carcinoma spreads to the small bowel primarily by direct extension from involved lymph nodes, most commonly from peraaortic or mesenteric nodes to the serosa of the bowel. But, the involvement of small bowel by cervical carcinoma is so rare, and shows a maximum incidence of small bowel involvement of less than 1.5%. We report a patient with squamous cell carcinoma of the cervix metastases to the second portion of the duodenum in whom the diagnosis was made by endoscopic biopsy of the lesion.

Inflammatory Fibroid Polyp of the Stomach Associated with Gastritis Cystica Profunda / 대한소화기내시경학회지

Inflammatory fibroid polyp(IFP) typically prescnts as a polypoid mass in the gastric antrum. Radiologically and endoscopically, it can be confused with polypoid carcinoma or submucosal stromal tumor. The histogenetic origin of IFP has been controversial, but it is considered as a reactive lesion of the myofibroblastic nature. IFP is rarely concomitant with gastritis cystica profunda(GCP) which is also one of the nonneoplastic inflammatory polyps. We report a case of IFP associated with GCP presenting as a large polypoid mass in the previously unoperated stomach of a 78-year-old woman. The mass was mainly located in the submucosa of the antrum and the cut surface exhibited a myxoid and glistening appearance with partial cystic change. Histologically, the mass showed marked proliferation of spindle cells, small blood vessels and many inflammatory cells, especially eosinophils. Also, there were many variable sized glands composed of gastric foveolar epithelia within the mass. In conclusion, the rarity of these two associated lesions in the present case may cause difficulty in diagnosis, and therefore recognition about these lesions is needed. In addition, this case supports the nature of IFP as being reactive rather than neoplastic.