The comparison of bacterial infection rate in the patients with alcoholic and viral cirrhosis / 대한내과학회지

BACKGROUND: Liver cirrhosis may be considered one of the most common cause of acquired immunodeficiency. Alcohol abuse may be predisposing factor to infections in patients with liver cirrhosis, so we compared the rate of spontaneous bacterial peritonitis (SBP) and other bacterial infections in alcoholic and viral liver cirrhosis. METHODS: We studied 188 patients who had been diagnosed with liver cirrhosis from January 1995 to June 2000 and evaluated the frequency of bacterial infections (SBP, pneumonia, urinary track infection, bacteremia, infectious colitis) retrospectively according to cause and degree of cirrhosis. RESULTS: Among 188 patients (alcoholic 76, viral 112), 64 patients (34%) presented with bacterial infection at hospitalization, 33 (43%;33/76) of 64 subjects were alcoholic and 31 (28%;31/112) of 64 subjects were viral liver cirrhosis. The rate of bacterial infections was higher in alcoholic liver cirrhosis than viral cirrhosis (p0.05). CONCLUSION: This results suggest that the rate of bacterial infections are more common in alcoholic than viral liver cirrhosis in relatively early stage and it may be influence the prognosis of liver cirrhosis.

Correlation of Helicobacter pylori Serology Titer with Endoscopic and Histologic Findings / 대한소화기내시경학회지

BACKGROUND/AIMS: In clinical practice, among the technique to detected Helicobacter pylori (H. pylori) infection, IgG serological test is noninvasive, safe, quick, widely available, and inexpensive. We studied that whether the titers of anti-H. pylori IgG antibody were correlated with endoscopic finding, and the degree of microscopic gastric damage and H. pylori density in dyspeptic patients. METHODS: Gastric biopsy specimens were obtained in 109 patients with H. pylori infection undergoing upper gastric endoscopy. The titers of serum IgG antibodies to H. pylori were measured by enzyme immunoassay. Macroscopic gastric damages and histologic grades were scored by the Sydney system. RESULTS: Endoscopic findings showed no significant association with H. pylori antibody titers (p=0.111). There was significant correlation between H. pylori antibody titers and lymphocyte infiltration (p=0.002), neutrophil infiltration (p=0.002), H. pylori density (p=0.0001), respectively. There was no significant correlation between H. pylori antibody titers and atropy (p=0.142), intestinal metaplasia (p=0.368), respectively. CONCLUSIONS: H. pylori antibody titer has significant association with the H. pylori density, neutrophil and lymphocyte infiltration. The serological test using EIA method is a useful in detecting H. pylori infection and it may be used as a predictor for the H. pylori density and degree of inflammation.

Thrombocytopenia between Decompensated Alcoholic and Viral Liver Cirrhosis / 대한간학회지

BACKGROUND/AIMS: Thrombocytopenia is frequently found among patients with chronic liver disease, and its mechanism, especially among patients with decompensated liver cirrhosis had not been established. Therefore to elucidate the mechanism of thrombocytopenia, the relationship between thrombocytopenia and severity of hepatic dysfunction, splenomegaly was measured. We measured the peripheral blood components with splenic volume obtained from a computerized tomography of decompensated liver cirrhosis patients. METHODS: We studied 103 patients who had been diagnosed with decompensated liver cirrhosis with esophageal varices and ascites from January 1982 to August 1999. We checked their counts of platelets, albumin, bilirubin, splenic volume, degree of esophageal varices, hepatic encephalopathy and ascites by retrograde methods. RESULTS: In viral liver cirrhosis, thrombocytopenia and splenomegaly correlated well with disease severity but they didn't in alcoholic cirrhosis. Of special note, the platelet count was significantly lower and the splenic volume was larger in the Child C of viral cirrhosis patients group than in the alcoholic group(p<0.05). CONCLUSION: When we compared decompensated alcoholic with viral liver cirrhosis patients, the degrees of thrombocytopenia and splenomegaly were much less in the former group. The factors for this phenomena are Splenic Pooling theory, Platelet-associated IgG, Thrombopoietin and Toxic Marrow. We suggest that splenomegaly is an important factor among these, but the mechanisms involved in the pathogenesis of this hematologic phenomena are not completely understood. Especially in alcoholic liver cirrhosis, many other factors may be involved, including the direct effect of alcohol to bone marrow, so further studies will be needed to establish whether a causal relationship exists.

A case of eosinophilic gastroenteritis with diffuse small bowel edema and ascites / 대한내과학회지

Eosinophilic gastroenteritis is an uncommon disorder of stomach, small bowel and colon characterized by peripheral blood eosinophilia, eosinophilic infiltration of the gut wall, and variable clinical symptoms. This disease was first described by Kaijser in 1937, and its cause was poorly understood. It may be related to allergy, which combines allergic rhinitis, allergic asthma, atopic dermatitis, food allergy and elevated IgE. The clinical symptoms and signs are variable according to the extents and depths of the eosinophilic infiltration. Endoscopic findings may show normal, nodular, ulcerative, or hemorrhagic mucosal changes, and biopsy findings reveal eosinophilic infiltration of mucosal and muscular layer. We diagnosed and treated a case of diffuse serosal eosinophilic gastroenteritis associated with ascites in a patient with allergic asthma who had severe abdominal pain, distention and watery diarrhea, and she dramatically responded to corticosteroid therapy.

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.

Esophgogastroduodenoscopic Findings in 9,137 Healthy Subjects Examined for the Secondary Prevention / 대한소화기내시경학회지

BACKGROUND: A esophagogastroduodenoscopy is now considered to be one of the essential rnethods for diagnosis of upper gastrointestinal disease. Furthermore early detection of stomach cancer by such a mass screening techique is very important to increase the survival rate. METHODS: A clinical analysis was conducted on 9,137 healthy subjects who had undergone a gastrofiberscopic examination for the secondary prevention, from January 1995 to December 1996, in Kangbuk Samsung hospital. RESULTS: 1) Number of cases with normal finding was 764 (8.4%). 2) The most prevalent disease found was chronic gastritis (82%). The number of cases with superficial gastritis was 64.7%, erosive gastritis 9.0%, atrophic gastritis 6.4% and metaplastic gastritis 1.6%. Atrophic and metaplastic gastritis were more frequent in the older age group. 3) The prevalence of peptic ulcer was 13.9% and duodenal ulcers (8.1%) was more common than gastric ulcers (5.8%, p<0.05) with a male to female ratio of 3.7: 1, and 2.1: 1 respectively. 4) Of the 10 cases with stomach cancer (0.11%), 5 cases (0.055%) were found to be advanced stomach cancer and the other 5 cases (0.055%) were early gastric cancer. The macroscopic type of early gastric cancer was type IIc in 4 cases and type IIb in another case, and 4 cases were limited in mucosa but another was in submucosa. The size of 4 cases were below 1 cm and there was no lymph node metastasis. CONCLUSION: Medically screened subjects were found to have many abnormalities, and therefore, it is recommanded that regular check ups using an endoscopy would be needed for early detection of early gastric cancer regardless of clinical symptoms.