Comparison between Conventional 4 L Polyethylene Glycol and Combination of 2 L Polyethylene Glycol and Sodium Phosphate Solution as Colonoscopy Preparation / 대한소화기학회지

BACKGROUND/AIMS: Effective bowel preparation is essential for accurate diagnosis of colon disease. We investigated efficacy and safety of 2 L polyethylene glycol (PEG) solution with 90 mL sodium phosphate (NaP) solution compared with 4 L PEG method. METHODS: Between August 2009 and April 2010, 526 patients were enrolled who visited Seoul National University Bundang Hospital for colonoscopy. We allocated 249 patients to PEG 4 L group and 277 patients to PEG 2 L with NaP 90 mL group. Detailed questionnaires were performed to investigate compliance, satisfaction and preference of each method. Bowel preparation quality and segmental quality were evaluated. Success was defined as cecal intubation time less than 20 minutes without any help of supervisors. RESULTS: Both groups revealed almost the same baseline characteristics except the experience of operation. PEG 4 L group's compliance was lower than PEG 2 L with NaP 90 mL group. Success rate and cecal intubation time was not different between two groups. Overall bowel preparation quality of PEG 2 L with NaP 90 mL group was better than PEG 4 L group. Segmental bowel preparation quality of PEG 2 L with NaP 90 mL group was also better than PEG 4 L group in all segments, especially right side colon. Occurrence of hyperphosphatemia was higher in PEG 2 L with NaP 90 mL group than PEG 4 L group. However, significant adverse event was not reported. CONCLUSIONS: PEG 2 L with NaP 90 mL method seems to be more effective bowel preparation than PEG 4 L method.

The clinical characteristics of noncardiac chest pain and treatment response in non-erosive reflux disease (NERD) / 대한내과학회지

BACKGROUND/AIMS: Noncardiac chest pain (NCCP) is defined as recurring angina-like retrosternal chest pain of noncardiac origin. Gastroesophageal reflux disease (GERD) is by far the most common cause of NCCP. We evaluated the incidence of some esophageal abnormalities as a cause of NCCP and the treatment response to a proton pump inhibitor (PPI). METHODS: Forty seven NCCP cases were selected from 184 cases who underwent 24-hour ambulatory pH monitoring or esophageal manometry. Patients were excluded if they had a history of gastrointestinal surgery, pancreatobiliary disorder, coronary artery disease, valvular heart disease, depression or tuberculosis. In this study, all GERD patients had non-erosive reflux disease (NERD). RESULTS: Of the 47 NCCP cases, 30 (63.8%) were female and 17 (36.2%) were male. Only 7 (14.9%) cases had typical GERD symptoms such as acid regurgitation and heartburn. Of the 47 NCCP cases, 12 (25.5%) had GERD-related NCCP, and six (12.8%) had esophageal motility disorder. Of the 12 cases diagnosed as GERD-related NCCP, nine (75.0%) showed a satisfactory PPI response. The PPI was effective for GERD-related NCCP compared with non-GERD related NCCP (p=0.015). CONCLUSIONS: About 40% of NERD patients with NCCP had an esophageal disorder including GERD and esophageal motility disorder. A PPI was effective for GERD-related NCCP.

Clinical Significance of Incidentally Detected Eosinophilic Esophagitis with Pathologic Review / 대한소화기학회지

BACKGROUND/AIMS: Eosinophilic esophagitis (EE) is a chronic inflammatory disorder characterized by abnormal dense eosinophilic infiltration of esophageal mucosa and results in dysphasia and food impaction. EE is being increasingly recognized in adults. The prevalence is largely unknown. This study was performed to evaluate the detection rate of EE diagnosed based on pathologic criteria and to define the clinical characteristics of EE in Korea. METHODS: We reviewed biopsy specimen of the 1,609 patients who underwent esophageal biopsy from January 2006 till August 2008. The presence of more than 20 eosinophils per high power field in biopsy specimens was considered cases of EE. Clinical information and endoscopic findings were obtained. RESULTS: 7 (0.4%) patients were diagnosed as EE based on pathologic criteria retrospectively. Clinical symptoms were epigastric pain (43%), regurgitation (29%), dyspepsia (14%), and no symptom (14%). Endoscopic findings were whitish exudates or granules (57%), esophageal polyp (29%), and hyperemic change (14%). Two patients received treatment. One patient with bronchial asthma improved after treatment with inhaled corticosteroid, and one patient improved after 8 week proton pump inhibitor therapy. CONCLUSIONS: Eosinophilic esophagitis was found in 0.4% of the total esophageal biopsied cases. Our results suggest that Korean patients with eosinophilic esophagitis showed symptoms mimicking gastroesophageal reflux disease and atypical endoscopic findings. Therefore, regardless of the gross appearance of the mucosa, meticulous diagnostic approaches are needed for patients with swallowing difficulty and lack of response to proton pump inhibitor.

Clinical Analysis of Recurrence Rate and Symptom Improvement in Gastro-esophageal Reflux Disease Patients / 대한소화기학회지

BACKGROUND/AIMS: Gastro-esophageal reflux disease (GERD) is a chronic condition, with 50-80% of patients experiencing recurrence within one year following completion of initial treatment. The present study aimed to estimate recurrence rate and treatment response in GERD patients treated with proton pump inhibitor. METHODS: A total of 207 symptomatic GERD patients, which were confirmed by endoscopy from July 2008 till January 2009, were enrolled. They were divided into non-erosive reflux disease (NERD) group and erosive reflux disease (ERD) group by endoscopic findings. Patients were treated with lansoprazole 15 mg (NERD group) or 30 mg (ERD group) once daily for 8 weeks. The presence of symptoms was assessed in each patient at baseline and post-treatment using a questionnaire. Subsequent symptomatic recurrence on the cessation of therapy in each improved patients was checked by telephone survey or outpatient interview. RESULTS: Ninety-four patients and 113 patients were first diagnosed with NERD and ERD, respectively. The mean post-treatment follow-up period was 24.4+/-8.5 weeks. Recurrence rate was 40.0% (NERD, 43.8%; ERD, 37.1% (p=0.224)). Recurrence time was 10.1+/-5.8 weeks (NERD 9.6 weeks; ERD, 10.6 weeks (p=0.444)). Regarding the symptom improvement after 8 week therapy with lansoprazole, 89.4% (NERD, 85.1%; ERD, 92.9% (p=0.056)) of total patients were symptomatically improved. CONCLUSIONS: Forty percentage of GERD patients recurred within 6 months following the completion of 8 week therapy with lansoprazole. Recurrence rate, recurrence time, and rate of symptom improvement were not significantly different between NERD group treated with half dose and ERD group treated with full dose lansoprazole.

Septic Metastatic Lesions Associated with Klebsiella pneumoniae Liver Abscess

Pyogenic liver abscess is a serious clinical disease with severe complication in about 10-20% of cases. Metastatic septic endophthalmitis and CNS infection are rare but their incidence is increasing in liver abscess patients, especially Klebsiella pneumoniae as etiologic bacteria. Despite appropriate treatment, the outcome is devastating. We experienced a case of septic endophthalmitis, CNS infection (meninigitis, ventriculitis) and infective spondylitis associated with K. pneumoniae liver abscess. The patient had no specific risk factor. After intensive treatement such as systemic intravenous antibiotics with percutaneous abscess drainage and intravitreal injection, liver abscess was resolved completely. But, sequelae were severe. Socket reconstruction after evisceration with debridement on both eye and ventriculo-peritoneal shunt due to hydrocephalus were done. Our experience suggests that attention should be paid to the possibility of septic metastatic lesions as soon as the treatment of K. pneumoniae liver abscess is initiated.

Septic Metastatic Lesions Associated with Klebsiella pneumoniae Liver Abscess

Pyogenic liver abscess is a serious clinical disease with severe complication in about 10-20% of cases. Metastatic septic endophthalmitis and CNS infection are rare but their incidence is increasing in liver abscess patients, especially Klebsiella pneumoniae as etiologic bacteria. Despite appropriate treatment, the outcome is devastating. We experienced a case of septic endophthalmitis, CNS infection (meninigitis, ventriculitis) and infective spondylitis associated with K. pneumoniae liver abscess. The patient had no specific risk factor. After intensive treatement such as systemic intravenous antibiotics with percutaneous abscess drainage and intravitreal injection, liver abscess was resolved completely. But, sequelae were severe. Socket reconstruction after evisceration with debridement on both eye and ventriculo-peritoneal shunt due to hydrocephalus were done. Our experience suggests that attention should be paid to the possibility of septic metastatic lesions as soon as the treatment of K. pneumoniae liver abscess is initiated.

Successful treatment of acute ischemic colitis with stent insertion / 대한내과학회지

Mesenteric ischemia is rare and is often diagnosed late. Fatal complications or acute ischemic events can occur in the absence of proper treatment. Any sensitive and specific tests are not available for functional diagnosis of mesenteric ischemia until now. If another causes of abdominal pain and weight loss have been confidently ruled out, evidence of visceral artery occlusion at noninvasive imaging (CT angiography, Doppler US, and MR angiography) suggests mesenteric ischemia. Until the 1990s, open surgery was considered the only treatment of choice. Percutaneous transluminal angioplasty (PTA) was reserved for patients to whom surgery carried a high risk. However, open surgery carries a non-egligible risk of morbidity and mortality. In recent years, PTA with stent placement has been recognized as a minimal invasive treatment option for obtaining good long term results with an acceptable recurrence rate and consequently has been suggested for primary treatment of mesenteric ischemia. We describe the successful application of PTA to the inferior mesenteric artery stenosis by using drug eluting stent.

The Comparative Study Of Cancer Incidence Between Urban And Rural Area In Gangneung: Gastric Cancer, Hepatoma And Lung Cancer / 대한내과학회지

BACKGROUND: Since most of epidemiologic studies of cancer disease in Korea are on the basis of data from large hospitals in metropolitan area, they neither represent the separate district, nor reflect the characters of rural area. We aimed to help prevent cancer and present control strategies in good accordance with regional features by evaluating the epidemiologic characters of cancers and performing a comparative study between urban and rural area. METHODS: We retrospectively reviewed the medical records of newly diagnosed cancer patients from January 1997 to December 2000 in Gangneung Asan Hospital, who resided in Gangneung city on diagnosis and investigated their pathologic results, radiologic findings, risk factors, stages, treatment modalities, etc. On the basis of them, we estimated incidence rates including crude rates and age standardized rates and compaed the differences between urban and rural area. RESULTS: The numbers of newly diagnosed cancer patients during this period were 367 in gastric cancer, 186 in hepatoma and 177 in lung cancer. The age standardized annual incidence rates of gastric cancer were estimated to be 49.7/17.8 (M/F) in urban area and 52.7/25.9 (M/F) in rural area per 100,000 persons. In hepatoma, the rates were 28.4/6.3 in urban and 36.3/6.5 in rural area and in the case of lung cancer, 23.5/6. 1 in urban and 32.0/7.4 in rural area. As a consequence, the age standardized annual incidence rates of rural area were higher than those of urban area in all the three cancers and the diffences were statistically significant except female hepatoma and lung cancer. However, risk factor survey among cancer patients revealed only difference in the amount of alcohol consumption associated with hepatoma, between urban and rural area. CONCLUSION: In rural area, the age standardized incidence rates were significantly higher than those of urban area in Gangneung city except female hepatoma and lung cancer. Moreover, in rural area, cancers were detected as more advanced state. Hence, preventive measures fit for these features were required urgently. In addition, more investigations about risk factors were needed to discover the cause of difference, including environmental and host factors which were not covered in this study.