Clinicopathological Characteristics of Colon Cancer Diagnosed at Primary Health Care Institutions

BACKGROUND/AIMS: The purpose of this study was to evaluate the clinicopathologic characteristics of colon cancers detected at the SOK Sokpeynhan Internal Medical Network, a nationwide system of primary health care institutions. METHODS: We analyzed 579 colon cancer patients diagnosed using colonoscopy at the SOK network from January 2011 through December 2012. Cancers from the rectum to the splenic flexure were classified as left colon cancer. Patients over 65 were classified as senior. RESULTS: The mean age (+/-SD) of subjects was 60.9+/-10.5 years and 61.1% were men. More than one quarter (28.2%) of patients were asymptomatic. The prevalence of left colon cancer was higher (77.9%) than that for right colon cancer. The most frequent macroscopic and histologic types were depressed (58.9%) and moderately differentiated adenocarcinoma (52.2%), respectively. Asymptomatic subjects displayed protruding or well differentiated adenocarcinoma, while symptomatic patients were more likely to display depressed or moderately differentiated adenocarcinoma (P0.05). CONCLUSIONS: Study results indicated an increase of colon cancer amongst younger demographics in recent years. The effectiveness of colonoscopy screening was also evident, as asymptomatic patients demonstrated frequent findings of well differentiated adenocarcinomas. Study results also suggested a need for closer examination of older patients, as right colon cancer tended to increase with age.

Clinicopathologic Characteristics of Superficial Gastric Cancer Diagnosed at Primary Health Care Institutions in 2011 / 대한소화기학회지

BACKGROUND/AIMS: Stomach cancer is prevalent in Korea. The purpose of this study was to evaluate the characteristics of superficial gastric cancers detected at SOK Sokpeynhan Internal Medical Network, the nationwide primary health care institutions. METHODS: We prospectively analysed the clinicopathologic and endoscopic characteristics of 218 superficial gastric cancer patients diagnosed using gastric endoscopy at SOK network from January 2011 through December 2011. RESULTS: The mean age was 58.5 years old and male to female ratio was 1.7 : 1. Asymptomatic patients were most common (45.0%). The macroscopic classification revealed that simple types (63.8%) were more common than complex types (36.2%). The most common type was IIc (28.4%) and other types were as follows; IIb (16.1%), IIb+IIc (13.3%), IIa (10.6%), III (9.2%), IIa+IIc (7.3%), IIc+IIa (6.0%), IIc+IIb (5.0%). The most commonly involved sites were the body (53.1%) and greater curvature (32.6%) of the stomach. The size of lesion was less than 1 cm (69.3%) and less than 5 mm (33.5%) in diameter. The most common pathologic type was tubular adenocarcinoma (75.7%). Helicobacter pylori infection rate was 50.2%. Fifty five percent of the cases were diagnosed via endoscopy of National Health Insurance Corporation screenings. CONCLUSIONS: Superficial gastric cancers in 2011 at primary health care SOK network were different from those of previous reports. Type IIc was most common but type IIb was more prevalent and the body and greater curvature of the stomach were the most commonly involved sites. Therefore, careful observation of the proximal gastric mucosa and mucosal color change is needed.

Candida esophagitis in a patient with HIV infection / 대한내과학회지

No abstract available.

Diagnosis and Management of Chronic Constipation

No abstract available.

A case of dedifferentiated liposarcoma in retroperitoneum / 대한내과학회지

Dedifferentiated liposarcoma occurs in less than 10% of all liposarcomas and is found most often in the retroperitoneum and extremities. Although cases of the primary dedifferentiated liposarcoma have been sporadically reported internationally, only one case with 8x4.5x4 cm size originated from spermatic cord and one case with 10x7x5 cm size in right gluteal region have been reported in Korea, but not in retroperitoneum. We report one case of the primary giant dedifferentiated liposarcoma occurred in retroperitoneum with 32x22x20 cm size and 4,250 g weight. A 56-year old man was admitted due to the weight loss and diffuse abdominal pain. The abdominal computed tomography showed that a round huge mass was pressing the surrounding structures and showed delayed enhancement. Surgical excision was carried out. Histologically the tumor was composed of well differentiated liposarcomatous area and malignant fibrous histiocytoma-like dedifferentiated area. The patient refused further treatment and now he is undergoing the follow-up.

The Prevalence of Gastroesophageal Reflux Disease in Patients with Nonspecific Esophageal Motility Disorder / 대한소화관운동학회지

BACKGROUND/AIMS: The nonspecific esophageal motility disorder (NEMD) has been reported to be related to gastroesophageal reflux disease (GERD) in some cases. However, the pathophysiologic mechanism of NEMD has not been estabilished. The aim of this study was to assess the prevalence of esophagitis and gastric acid reflux following abnormal contractions in patients with NEMD. METHODS: 122 NEMD patients were enrolled (76 male and 46 female) and their endoscopic findings and 24 hour esophageal pH data were compared with 24 healthy subjects. The abnormal contractions were classified as 1) non-transmitted contraction, 2) low amplitude contraction, 3) non-transmitted and low amplitude contraction, and 4) others. RESULTS: Among the 122 patients with NEMD, 62 patients (50.8%) had GERD, 53 patients (43.4%) had endoscopic reflux esophagitis, and 41 patients (33.6%) had both. Acid exposed time studied by 24 hour pH monitoring was more increased in NEMD patients than in healthy controls (7.48 +/- 10.68 vs 1.42 +/- 1.17), but there were no differences among abnormal contraction patterns. Moderate to severe reflux esophagitis were frequently seen in patients with combined abnormal contractions as the results of endoscopic findings. Pre-existing factors for the gastric acid reflux in NEMD patients were male and esophageal hiatal hernia. CONCLUSIONS: Large numbers of NEMD patients were found to have concurrent GERD in our study. However, the esophageal peristaltic dysfunction was more closely related to the severity of esophagitis rather than to the amount of refluexed gastric acid itself.

Gastroesophageal Acid Reflux According to Different Meals: Flour Cake vs Rice Cake / 대한소화관운동학회지

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is known to be one of the contributing factors to cause epigastric soreness, which we often experience after intake of flour-based meals. The aim of this study was to evaluate gastroesophgeal reflux (GER) and its mechanism according to intake of different ingredients of meals. METHODS: We investigated the effect of meals of different ingredients on the lower esophageal sphincter (LES) pressure, the frequency of transient LES relaxation (tLESR) and GER in seven healthy volunteers. The meals used in this study were either rice cakes or flour cakes, which were isocaloric and isovolumetric. A mylohyoid electromyogram, LES pressure and esophageal pH were simultaneously recorded for 3 hours after ingestion of each meal on two different occasions. RESULTS: There was no significant difference in incidence of GER between two meals. CONCLUSION: The intake of isocaloric and isovolumetric meals of either flour or rice cake did not result in significant discrepancies in frequency of GER. The increase in the frequency of swallow- and strain-associated GER observed in the case of a flour cake may be caused by reduced LES pressure after ingestion.

Usefulness of Giemsa Staining and Campylobacter-Like Organism (CLO) Test Following Helicobacter pylori Eradication Therapy / 대한소화기내시경학회지

BACKGROUND/AIMS: Follow-up studies with low sensitivity and specificity make it difficult to predict precisely long-term effect of H. pylori eradication therapy. The aim of this prospective study was to evaluate the usefulness of Giemsa staining and CLO test following eradication therapy. METHODS: In this study, H. pylori eradication therapy was done in 99 consecutive peptic ulcer patients and followed at 1, 6, and 12 months. Follow-up diagnosis was performed by Giemsa staining and CLO test using 6 specimens taken from the gastric antrum and midbody. Eradication was considered if the results of the two tests were negative. RESULTS: Overall the results of 63 (64%) patients among 99 patients who followed more than 6 months did not changed including 9 persistent positive, and 54 negative. However, the result of 36 patients changed to 21 positive and 15 negative conversion after 6 months. The estimated sensitivity, specificity, positive predictive value, negative predictive value of the Giemsa staining and CLO test, using PCR and culture as 'gold standard', were 67%, 85%, 82%, 70%, respectively. CONCLUSIONS: Sensitivity and specificity of Giemsa staining and CLO test following eradication therapy are lower than other reports. It is suggested that the large, multicenter prospective study is necessary to prove diagnostic accuracy of those follow-up studies.

Relationship between the Shape of the Gastroesophageal Junction and Gastroesophageal Acid Reflux / 대한소화관운동학회지

BACKGROUND/AIMS: The competency of the gastroesophageal junction (GEJ) holds the key in unlocking pathophysiologic mechanisms of gastroesophageal reflux disease (GERD). However, a relationship between GERD and the incompetent GEJ has not been established. The aim of our study was to assess the relationship between the shape of the GEJ and gastroesophageal acid reflux. METHODS: Forty six patients with reflux symptoms underwent an endoscopy, esophageal manometry and 24-hour esophageal pH monitoring. Patients were placed in 3 groups according to the shape of their GEJ, categorized by a retroflex view of the endoscopy; type I - gastroesophageal fold without a pouch, type II - no pouch and no fold, and type III - a pouch without a fold. RESULTS: In type II and III, LESP was reduced. However, % of time with the pH < 4.0 was increased in type III only. There was a significant correlation between the size of a hiatal hernia and the shape of the GEJ. There was a relationship between the grade of esophagitis and the shape of the GEJ. CONCLUSIONS: The retroflex endoscopic finding of the GEJ focusing on the presence or absence of a GE fold and hiatal pouch, could be an indicator of whether a patient has GERD.

The usefulness of PCR-based restriction fragment length polymorphism (RFLP) analysis for differentiating Helicobacter pylori strains after the triple therapy / 대한내과학회지

BACKGROUND: The aim of this prospective study was to evaluate the usefulness of PCR-based restriction fragment length polymorphism (RFLP) analysis for differentiating H. pylori strains after the triple therapy in patients with duodenal ulcer. METHODS: Following a 1-2 week regimen of omeprazole 40 mg, amoxicillin 2.0 g, and clarithromycin 1.0 g, twice daily, twenty patients with duodenal ulcer were enrolled. Ten patients (group 1) were not successfully treated, and another 10 patients (group 2) exhibited recurrence of infection. Follow-up diagnosis was performed by Giemsa stain and CLO test. RFLP profiles of antral and midbody biopsy specimens were compared before and after therapy. PCR products using the ureC gene were digested with restriction enzymes Hha I, Mbo I, and Hind III, and the fragments generated were analyzed by agarose gel electrophoresis. RESULTS: Hha I, Mbo I, and Hind III digestion produced 13, 7, and 2 distinguishable digestion patterns, respectively. There was no difference in RFLP profiles before and after the therapy in 17 duodenal ulcer patients, while different RFLP profiles following therapy were discovered in 3 patients. Following treatment, one (group 2) patient differed in Mbo I, and two (one each from both groups) patients differed in Hha I and Mbo I RFLP patterns. CONCLUSION: This study supports the hypothesis that PCR-based RFLP analysis can be useful for differentiating reinfection and recrudescence of H. pylori strains following triple therapy.

Usefulness of laparoscope for the staging of advanced gastric cancer without distant metastasis in abdominal CT and EUS / 대한내과학회지

BACKGROUND: The proper staging of advanced gastric cancer has crucial role in determining resectability and operative method, to prevent unnecessary operation and to predict the prognosis and survival rate. Although marked improvements have been made in computed tomography (CT) technology and endoscopic ultrasonography (EUS) in recent years, reassessment of the laparoscopy for gastric cancer is required as a preoperative staging tool. Therefore, we determined the usefulness of laparoscopy for staging of advanced gastric cancer without distant metastasis in CT and EUS. METHODS: Staging laparoscopy was performed in 48 patients with advanced gastric cancer staged T3 or T4 by CT and EUS. Laparoscopy was carried out with the patients under local anesthesia, and included visual inspection of abdomen, and biopsies for suspicious metastatic lesions. Laparoscopic results were compared with the postoperative pathologic findings. RESULTS: Laparoscopy was performed successfully in 48 patients. Laparoscopy disclosed unrecognized distant metastases in 7 patients (14.6%) judged to be eligible for potentially curative resection by CT and EUS. Preoperative laparoscopy showed an accuracy of 74% for serosal infiltration. CONCLUSION: Our results suggest that laparoscopy is an effective means of evaluating resectability of advanced gastric cancer staged T3 or T4 and can provide valuable help in planning surgical approach.

Electron microscopic study of adhesion between Helicobacter pylori and gastric epithelial cell / 대한내과학회지

BACKGROUND: The purpose of this study was to investigate the ultrastructural relation of H. pylori and gastric epithelial cells in their adhesion. METHODS: Endoscopic biopsy of gastric antrum and body was performed from 15 patients (9 men, 6 women) with chronic gastritis. These specimens were processed and observed by transmission electron microscope (Hitachi H-600). RESULTS: On the basis of morphological appearances, the different types of adhesion of the organism with the epithelial cells were categorized as filamentous connection, adhesion pedestals, membrane fusion. Coccoid and intermediate forms were associated with filamentous connection whereas bacillary forms were associated with adhesion pedestals and membrane fusion. CONCLUSION: Various types of adhesion were associated with H. pylori and gastric epithelium. Further studies are needed to investigate biophysiologic influence to epithelial cells by ultrastructural relationship.(Korean J Med 60:16-21, 2001)

Differentiation between reinfection and recrudescence of helicobacter pylori strains using PCR-based restriction fragment length polymorphism analysis

The aim of this study was to evaluate whether PCR-based restriction fragment length polymorphism (RFLP) analysis was effective in differentiating between reinfection and recrudescence of H. pylori strains. Following a 1-2 week regimen of omeprazole 20 mg, amoxicillin 1.0 g, and clarithromycin 500 mg twice daily, twenty patients with duodenal ulcer were enrolled in the study. Ten patients (group 1, control) were not successfully treated, and another 10 patients (group 2) exhibited recurrence of infection 6-24 months following the therapy. Follow-up diagnosis was performed by Giemsa stain and CLO test. RFLP profiles of antral and midbody biopsy specimens were compared before and after therapy. PCR products using the ureC gene were digested with restriction enzymes Hha I, Mbo I, and Hind III, and the fragments generated were analyzed by agarose gel electrophoresis. Hha I, Mbo I, and Hind III digestion produced 13, 7, and 2 distinguishable digestion patterns, respectively. There was no difference in RFLP profiles seen before and after the therapy in 17 duodenal ulcer patients, while different RFLP profiles were discovered in 3 patients. Following treatment, one (group 2) patient differed in Mbo I, and two (one each from both groups) patients differed in Hha I and Mbo I RFLP patterns. Eight of group 2 patients showed recrudescence of previous infection and two patients had reinfection by another strain. This study supports the hypothesis that PCR-based RFLP analysis can be effective for differentiating reinfection and recrudescence of H. pylori strains following triple therapy.

A Case of Small Intestinal Burkitt's Lymphoma in an Adult / 대한소화기내시경학회지

Burkitt's lymphoma is a rare disease that belongs to the aggressive non-Hodgkin's lymphomas. Burkitt's lymphoma usually occurs in children or younger persons. There is a strong association between endemic Burkitt's lymphoma and Epstein-Barr virus, whereas the association is weaker in the sporadic form occurring in Western countries. Burkitt's lymphoma of the gastrointestinal tract occurring in adults has not been reported in Korea. We herein report an unusual case of Burkitt's lymphoma presenting with a palpable abdominal mass in a 52-year-old man infected with Epstein-Barr virus. A computed tomographic scan showed marked low density wall thickening of the terminal ileum. An endoscopy revealed a narrow lumen, shallow ulcerations, and irregular nodularity of the terminal ileum. Small bowel resection and hemicolectomy were performed and a histologic examination of the resected specimen confirmed the diagnosis. Six cycles of adjuvant chemotherapy were given and the patient has been doing well without evidence of recurrence.

Endoscopic Removal of an Impacted Sharp Foreign Body in the Esophagus / 대한소화기내시경학회지

BACKGROUND/AIMS: Sharp impacted esophageal foreign bodies can be very difficult to manage. When attempting to remove such objects inappropriately, life threatening complications, such as perforation can occur. Terefore, surgical intervention generally affords a safer approach. The aim of this study was to evaluate the safety and efficacy of endoscopic remval of sharp impacted esophageal foreign bodies using a dilatation method with an oral side balloon. METHODS: A total of 17 patients (7 Male, 10 Female)with sharp impacted esophageal foreign bodies underwent endoscopic Extraction. The following technique was successfully performed; an oral side balloon (Top Co., Japan) for esophageal variceal sclerotherapy was attached on the distal part of the endoscope. Under local anesthesia, the endoscope was inserted near the proximal part of the esophageal foreign body. Then, the oral side balloon was gradually dilated. Dilataion of the proximal part of the esophagus made it possible to release the sharp impacted foreign body from the esophageal wall. RESULTS: The types of foreign bodies were fish bones (6 cases), press-through packages (6 ases), chichen bones (3 cases), dentures (1 case), and a watch (1case). Endoscopic removal was successful in all 17 cases without complications such as perforation. CONCLUSIONS: This method of using an oral side balloon is safe and effective in removing sharp impacted esophageal foreign bodies, preventing, surgery and possible perforation.

Effects of Gabexate Mesilate for the Prevention of Pancreatic Damage Related to ERCP / 대한소화기내시경학회지

BACKGROUND/AIMS: Recent studies reported that 1g of gabexate mesilate (GM) was effective in preventing endoscopic retrograde cholangiopancreatography (ERCP)-related pancreatic damage. The aim of this study was to evaluate the effectiveness of low dose GM for the prevention of ERCP-related pancreatic damage. METHODS: This study was performed prospectively with 102 consecutive patients (68 for the GM group, 34 for the placebo group) who were scheduled for ERCP. Infusion of GM (500 mg) was started 30 minutes before ERCP and continued for 12 hours afterward. The serum amylase and lipase were measured before ERCP and 4, 8, and 24 houps after ERCP. RESULTS: The incidence of hyperenzymemia was 45.6% in the GM group and 55.9% in the control group (p=0.40). Acute pancreatitis was developed in only one patient who was given the placebo. Although difficult cannulation, visualization of the pancreatic duct, performance of therapeutic procedures, and longer total procedure time were associated with an increased incidence of hyperenzymemia, the incidence of pancreatic damage was not affected by the GM treatment in these conditions. CONCLUSIONS: Prophylactic treatment with 500 mg of GM has no advantage for the prevention of ERCP-related pancreatic damage. Considering the cost effectiveness, further studies are necessary to identify the patients at greatest risk fot acute pancreatitis.

Two Cases of Cronkhite - Canada Syndrome with Remission / 대한소화기내시경학회지

The Cronkhite-Canada Syndrome (CCS) is a monfamilial disorder of adults characterized by diffuse gastro-intestinal polyposis, ectodermal changes consisting of alopecia, dystrophy of nails and cutaneous hyper-pigmentation. The pathogenesis and the causes of CCS remain unknwon but the symptoms such as diarrhea and malnutrition are generally progressive, and the prognosis is knwon to be poor. Though the definitive treatment is not well known, it has been reported that the conservative management is the most important treatment, and that the clinical sourse can be reversible. One case was experienced involving Cronkhite-Canada Syndromen in a patient who was managed by conservative treatment and an other who was treated by corticosteroid. These two cases are reported herein with a review of corresponding literature.

The diagnostic value of serum and fecal pancreatic elastase-1 in patients with pancreatic disease / 대한내과학회지

BACKGROUND: The aims of this study were to evaluate the diagnostic value of pancreatic elastase-1(PE-1) in patients with pancreatic diseases and compare the significance of PE-1 with that of pancreatic exocrine function test by pure pancreatic juice (PPJ) collection. METHODS: For evaluation of PE-1, seventy nine patients with pancreatic diseases were examined. For evaluation of exocrine pancreatic function by PPJ, twenty three patients with Chronic pancreatitis(CP) were examined. PPJ was collected by endoscopic cannulation of main pancreatic duct under the intravenous bolus injection of secretin (0.25 CU/kg body weight) and cholecystokinin (CCK, 40 ng/kg body weight). RESULTS: Pancreatic exocrine functions were significantly decreased in patients with CP showing moderate and severe ductal changes on pancreatogram. The mean concentration of fecal PE-1 was significantly decreased in patients with CP and pancreatic cancer, but not in patients with acute pancreatitis. When we analyzed the PE-1 concentration according to Cambridge classification, the concentration of fecal PE-1 was significantly decreased only in patients with moderate and severe CP. With a cut off of 200 ug fecal PE-1/g, the sensitivity of PE-1 was 25%, 60%, and 100%, respectively, for mild, moderate and severe CP, and the specificity was 88.1%. The mean concentration of serum PE-1 was increased both in patients with acute and chronic pancreatitis, but there was no difference between both group. CONCLUSION: Fecal PE-1 is useful for diagnosis of pancreatic exocrine insufficiency in patients with CP, especially in moderate and severe grade of pancreatic exocrine insufficiency. The diagnostic value of fecal PE-1 was also similar to secretin-CCK test in pancreatic exocrine insufficiency.

Changes of Esophageal Motor Function Depending on the Different Types of the Bolus / 대한소화관운동학회지

BACKGROUND/AIMS: It is suggested that diffuse esophageal spasm (DES), nutcracker esophagus (NUT), and hypertensive lower esophageal sphincter (HLES) could be re-classified together as a spastic esophageal motility disorder of similar clinical backgrounds. However, there were no studies to evaluate the pathophysiological characteristics of these motor abnormalities. The aim of the study was to evaluate the changes of esophageal motor function depending on the different types of the bolus (water vs semi-solid bolus). METHODS: Twenty-one healthy subjects and 42 subjects with primary esophageal motility disorders (4 DES, 12 NUT, 5 HLES, 12 nonspecific esophageal motility disorders, 9 normal) underwent a perfusion manometry with a low compliance pneumo-hydraulic capillary infusion system. Consecutively, each patient had 10 swallows of water and 10 swallows of Jello, 5 ml each. RESULTS: In the healthy controls, the Jello swallow showed an increased amplitude and duration of distal esophageal contractions, and the velocity of peristalsis was decreased (p < 0.05). Among all patients diagnosed by manometry with the water swallow, 2 cases diagnosed with HLES (40%) and 4 with NUT (33%) were changed to a diagnoses of DES after the Jello swallow. Moreover, HLES was found in 1 patient with DES (25%) and in 6 patients with NUT (50%). CONCLUSIONS: Semi-solid bolus swallows increase the contractile force of the esophagus more than water swallows. A conventional manometric diagnosis could be changed to a different spastic motility disorder of the esophagus after a semi-solid bolus swallow. It is suggested that DES, NUT, and HLES can be considered as a spectrum of spastic esophageal motility disorders sharing a similar pathophysiology.

Endoscopic Removal of Embedded Chicken Bone from Sigmoid Colon Using Balloon Dilatation / 대한소화기내시경학회지

Ingested foreign bodies usually pass through the digestive system uneventfully. The diagnosis of inadvertently swallowed foreign bodies is usually delayed. It often induces serious complications, such as perforation, enterocolic fistula, abscess formation, or aortointestinal fistula. Therapeutic colonoscopy has replaced to a significant degree the need for traditional open surgical procedures to extract foreign bodies from the colon. Various foreign bodies may be extracted from the colon by a number of endoscopic techniques. We describe a case of a patient who presented with abdominal pain, loose stool during 3 months due to the impaction of a chicken bone in the sigmoid colon. The chicken bone was successfully removed by using balloon dilatation during colonoscopy.