The meaning of warning symptoms in the patients with dyspepsia / 대한내과학회지

BACKGROUND: We tried to assess whether the presence of warning symptoms and age could be useful indicators for performing endoscopy in patients who suffer from various organic gastrointestinal diseases. METHODS: Between May 2005 to August 2005, 827 subjects who visited the health care center were studied via questionnaires and performing upper endoscopy. The questionnaires evaluated the presence and pattern of dyspepsia and the warning symptoms. RESULTS: A total of 808 patients were enrolled. The mean age of patients was 44.6+/-8.9 years (mean+/-SD) with a male to female ratio of 1.2:1. 153 patients (18.9%) were diagnosed with confirmed organic diseases and 52 patients (6.4%) were diagnosed with definite organic diseases. The total number of organic diseases and definite organic diseases (gastroduodenal ulcer, reflux esophagitis and advanced gastric cancer) was statistically higher in the male population (p=0.001 in both). The relative risk of dyspepsia, the presence of warning symptoms and each warning symptom for the organic disease and definite organic diseases were not consistently higher for the males or females. The males over fifty years and the males over sixty years age had a relative risk of 2.046 (95% CI: 1.27~3.30) and 3.105 (95% CI: 1.39~6.95) for organic disease and 1.913 (95% CI: 0.97~3.77) and 5.333 (95% CI: 2.15~13.22) for definite organic disease, respectively. For the male patients over fifty or sixty years old with dyspepsia or warning symptoms, there were tendencies to increase the relative risk of definite organic disease rather than organic disease. CONCLUSIONS: The relative risk of organic diseases in the presence of warning symptoms in males of over fifty years or sixty years age was not sufficiently significant for differentiating organic diseases. Thus, warning symptoms, old age and presence of dyspepsia alone can not be used as a predictor to guide endoscopic examination.

The Usefulness of Capsule Endoscopy in Patients with Obscure Gastrointestinal Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: Obscure gastrointestinal bleeding (OGIB) is defined as recurrent bleeding for which no source has been identified by routine endoscopic and contrast studies. This study was performed to determine the utility of capsule endoscopy in patients with OGIB. METHODS: This retrospective study included 21 patients with GIB which were not identified by esophagogastroduodenoscopy and colonoscopy. Those were sixteen patients with overt OGIB (including 6 ongoing overt bleeding) and five with occult OGIB. All underwent capsule endoscopy with Given M2A video capsule system. RESULTS: Definite bleeding of small intestine were identified in 9 of 21 patients (42.9%) and 8 of 9 patients presenting as overt OGIB (50.0%, 8/16). Additionally, 5 of 6 patients with ongoing bleeding on the day of capsule endoscopy were found to have the lesion in small intestine (83.3%, 5/6). Ulcers were found in 6 patients, diverticulitis in 2 patients, and a tumor in 1 patients. CONCLUSIONS: Capsule endoscopy, providing a good visualization of small intestine, is safe and well tolerated. Capsule endoscopy is an useful diagnostic tool for OGIB, especially for ongoing overt bleeding, and can guide the subsequent therapy and expand diagnostic yield in OGIB.

A Case of Colonic Giant Lipoma Removed by Endoscopic Resection / 대한소화기내시경학회지

Colonic lipomas represent mesenchymal origin tumors that are second most common benign colonic tumor after hyperplastic polyps and adenomatous polyps. The patho-genesis of them is not clear. Most patients are asymptomatic and the lesion is often detected incidentally at colonoscopy, operation, and autopsy. According to the size and the location of lipoma, it may cause intestinal obstruction, perforation, intussusception, and life-threatening bleeding. There have been many reports of small colonic lipomas removed by endoscopic resection. Giant lipoma which is greater than 2 cm in size has been associated with higher risk of perforation, thus it has been removed by surgery until now. We report a case of colonic giant lipoma inducing intussusception which could be removed by endoscopic resection.