Nonalcoholic Fatty Liver Disease Is Associated with Benign Prostate Hyperplasia

Background@#Nonalcoholic fatty liver disease (NAFLD) is associated with a wide spectrum of metabolic abnormalities. This study aimed to evaluate whether NAFLD is associated with benign prostatic hyperplasia (BPH) independent of other risk factors. @*Methods@#A total of 3,508 subjects who underwent prostate and hepatic ultrasonography were enrolled. NAFLD was diagnosed and graded by ultrasonographic findings. BPH was defined by total prostate volume. @*Results@#The prevalence of BPH was significantly increased according to NAFLD severity (P < 0.001). The multivariate analysis showed that NAFLD was associated with a 22% increase in the risk of BPH (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.02–1.45). In non-obese subjects, NAFLD was associated with a 41% increase in the risk of BPH (OR, 1.41; 95% CI, 1.14–1.73), and an incremental increase in the risk of BPH according to NAFLD severity was pronounced (adjusted OR [95% CI], 1.32 [1.05–1.68] for mild NAFLD, 1.55 [1.15–2.10] for moderate to severe NAFLD vs. no NAFLD, P for trend = 0.004). However, in the obese population, the association of NAFLD in the risk of BPH was insignificant (P = 0.208). @*Conclusion@#NAFLD is associated with an increased risk of BPH regardless of metabolic syndrome, especially in non-obese subjects. An incrementally increased risk of BPH according to NAFLD severity is prominent in non-obese subjects with NAFLD. Thus, physicians caring for non-obese patients with NAFLD may consider assessing the risk of BPH and associated urologic conditions.

Association Between Anxiety and Depression and Gastroesophageal Reflux Disease: Results From a Large Cross-sectional Study

BACKGROUND/AIMS: The different clinical manifestations of gastroesophageal reflux disease (GERD) may be influenced by associated psychological factors. We evaluated the psychological status (anxiety and depression) according to each subtype of GERD. METHODS: Subjects who underwent esophagogastroduodenoscopy and completed a symptom questionnaire between January 2008 and December 2011 were analyzed. The subjects were classified into the following groups: erosive reflux disease (ERD), non-erosive reflux disease (NERD), asymptomatic erosive esophagitis (AEE), and controls. Anxiety and depression were assessed using the State-Trait Anxiety Inventory and Beck Depression Inventory, respectively. RESULTS: We analyzed 19 099 subjects: 16 157 (84.6%), 176 (0.9%), 1398 (7.3%), and 1368 (7.2%) in the control, ERD, NERD, and AEE groups, respectively. Multiple multinomial logistic regression revealed a significant association of increased state (adjusted OR, 1.89; 95% CI, 1.53–2.33) and trait anxiety (adjusted OR, 1.78; 95% CI, 1.34–2.35) and depression (adjusted OR, 2.21; 95% CI, 1.75–2.80) with NERD. ERD group showed a significant association only with state anxiety (adjusted OR, 2.20; 95% CI, 1.27–3.81) and depression (adjusted OR, 2.23; 95% CI, 1.18–4.22). The AEE group, however, did not show any significant association with psychological factors. CONCLUSION: This cross-sectional study revealed that anxiety and depression levels were significantly higher in subjects with GERD (notably in the NERD) than in controls.

Genetic Polymorphisms of PNPLA3 and SAMM50 Are Associated with Nonalcoholic Fatty Liver Disease in a Korean Population

BACKGROUND/AIMS: The development of nonalcoholic fatty liver disease (NAFLD) is associated with multiple genetic and environmental factors. METHODS: We performed a genome-wide association study to identify the genetic factors related to NAFLD in a Korean population-based sample of 1,593 subjects with NAFLD and 2,816 controls. We replicated the data in another sample that included 744 NAFLD patients and 1,137 controls. We investigated single-nucleotide polymorphisms (SNPs) that were related to NAFLD. RESULTS: After adjusting for age, sex and body mass index, rs738409, rs12483959 and rs2281135, located in the PNPLA3 gene, were validated in our population (p < 8.56×10⁻⁸) in the same linkage disequilibrium block. Additionally, rs2143571, rs3761472, and rs2073080 in the SAMM50 gene showed significant associations with NAFLD (p < 8.56×10⁻⁸). Furthermore, these six SNPs showed significant associations with the severity of fatty liver (all p < 2.0×10⁻¹⁰ in the discovery set and p < 2.0×10⁻⁶ in the validation set) and NAFLD, with elevated levels of alanine aminotransferase (all p < 2.0×10⁻¹⁰ in the discovery set and p < 2.0×10⁻⁶ in the validation set). CONCLUSIONS: We demonstrated that the PNPLA3 and SAMM50 genes are significantly associated with the presence and severity of NAFLD in a Korean population. These findings confirm the important roles of genetic factors in the pathogenesis of NAFLD.

Training Effect on the Inter-observer Agreement in Endoscopic Diagnosis and Grading of Atrophic Gastritis according to Level of Endoscopic Experience

BACKGROUND: Endoscopic diagnosis of atrophic gastritis can contribute to risk stratification and thereby tailored screening for gastric cancer. We aimed to evaluate the effect of training on inter-observer agreement in diagnosis and grading of endoscopic atrophic gastritis (EAG) according to the level of endoscopists' experience. METHODS: Twelve endoscopists (six less-experienced and six experienced) participated in this prospective study. The training session consisted of 1) four interventions with two-week intervals, and 2) a follow-up period (two follow-up assessments without feedback). EAG was categorized as C1 to O3 according to the Kimura-Takemoto classification. Kappa statistics were used to calculate inter-observer agreement. RESULTS: At baseline, kappa indexes were 0.18 in the less-experienced group and 0.32 in the experienced group, respectively. After four interventions with feedback, the kappa index improved in both groups and was sustained during the follow-up period. Overall diagnostic yields of EAG were 43.1% ± 10.7% in pre-intervention and 46.8% ± 5.9% in post-intervention. Variability in the rate of diagnosis of EAG significantly decreased in the less-experienced group (r = 0.04, P = 0.003). CONCLUSION: Irrespective of experience level, inter-observer agreement for diagnosis and grading of EAG improved after training and remained stable after intervention.

Development of Metachronous Tumors after Endoscopic Resection for Gastric Neoplasm according to the Baseline Tumor Grade at a Health Checkup Center / 대한소화기학회지

BACKGROUND/AIMS: Endoscopic resection (ER) procedure has been performed widely to treat gastric neoplasms. Here, we compared the long-term prognosis based on the clinical features of three types of recurred gastric neoplasms after ER, including low-grade dysplasia (LGD), high-grade dysplasia (HGD), and early gastric carcinoma (EGC). METHODS: Between 2003 and 2014, subjects who were diagnosed with gastric neoplasm during screening endoscopy were included. The baseline clinicopathologic and tumor recurrence were analyzed. RESULTS: Of the 316 patients enrolled, 170 patients (53.8%) were categorized into the LGD group, 34 patients (10.8%) into the HGD group, and 112 patients (35.4%) into the EGC group. The median follow-up duration was 4.2 years. Among the total, 14 patients experienced a development of metachronous gastric cancer; 4 patients (2.3%) in the LGD group, 3 patients (8.3%) in the HGD group, and 7 patients (6.1%) in the EGC group. Metachronous gastric neoplasm had developed in 17 LGD patients (10.0%), 5 HGD patients (14.7%), and 14 EGC patients (12.5%). There was no significant difference in the incidence of metachronous gastric cancer and neoplasm among the three groups (p=0.15 and p=0.72, respectively). CONCLUSIONS: We identified that the incidence rates of gastric neoplasm and cancer after endoscopic treatment were not significantly different between the LGD, HGD, and EGC groups.

Management of Suspicious Mucosa-Associated Lymphoid Tissue Lymphoma in Gastric Biopsy Specimens Obtained during Screening Endoscopy

It is often difficult to differentiate gastric mucosa-associated lymphoid tissue (MALT) lymphoma from Helicobacter pylori-associated follicular gastritis, and thus, it becomes unclear how to manage these diseases. This study aimed to explore the management strategy for and the long-term outcomes of suspicious gastric MALT lymphoma detected by forceps biopsy during screening upper endoscopy. Between October 2003 and May 2013, consecutive subjects who were diagnosed with suspicious gastric MALT lymphomas by screening endoscopy in a health checkup program in Korea were retrospectively enrolled. Suspicious MALT lymphoma was defined as a Wotherspoon score of 3 or 4 upon pathological evaluation of the biopsy specimen. Of 105,164 subjects who underwent screening endoscopies, 49 patients with suspicious MALT lymphomas who underwent subsequent endoscopy were enrolled. Eight patients received a subsequent endoscopy without H. pylori eradication (subsequent endoscopy only group), and 41 patients received H. pylori eradication first followed by endoscopy (eradication first group). MALT lymphoma development was significantly lower in the eradication first group (2/41, 4.9%) than in the subsequent endoscopy only group (3/8, 37.5%, P = 0.026). Notably, among 35 patients with successful H. pylori eradication, there was only one MALT lymphoma patient (2.9%) in whom complete remission was achieved, and there was no recurrence during a median 45 months of endoscopic follow-up. H. pylori eradication with subsequent endoscopy would be a practical management option for suspicious MALT lymphoma detected in a forceps biopsy specimen obtained during screening upper endoscopy.

The serum vitamin D level is inversely correlated with nonalcoholic fatty liver disease

BACKGROUND/AIMS: A low vitamin D level has been associated with metabolic syndrome and diabetes. However, an association between a low vitamin D level and nonalcoholic fatty liver disease (NAFLD) has not yet been definitively established. This study aimed to characterize the relationship between a vitamin D level and NAFLD in Korea. METHODS: A cross-sectional study involving 6,055 health check-up subjects was conducted. NAFLD was diagnosed on the basis of typical ultrasonographic findings and a history of alcohol consumption. RESULTS: The subjects were aged 51.7±10.3 years (mean±SD) and 54.7% were female. NAFLD showed a significant inverse correlation with the vitamin D level after adjusting for age and sex [odds ratio (OR)=0.85, 95% confidence interval (CI)=0.75-0.96]. The age- and sex-adjusted prevalence of NAFLD decreased steadily with increasing vitamin D level [OR=0.74, 95% CI=0.60-0.90, lowest quintile (≤14.4 ng/mL) vs highest quintile (≥28.9 ng/mL), p for trend 20 ng/mL) [OR=0.86, 95% CI=0.75-0.99] and the quintiles of the vitamin D level in a dose-dependent manner (p for trend=0.001). CONCLUSIONS: The serum level of vitamin D, even when within the normal range, was found to be inversely correlated with NAFLD in a dose-dependent manner. Vitamin D was found to be inversely correlated with NAFLD independent of known metabolic risk factors. These findings suggest that vitamin D exerts protective effects against NAFLD.

Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

BACKGROUND/AIMS: A percutaneous gastrostomy can be placed either endoscopically (percutaneous endoscopic gastrostomy, PEG) or radiologically (radiologically-inserted gastrostomy, RIG). However, there is no consistent evidence of the safety and efficacy of PEG compared to RIG. Recently, 30-day mortality has become considered as the most important surrogate index for evaluating the safety and efficacy of percutaneous gastrostomy. The aim of this meta-analysis was to compare the 30-day mortality rates between PEG and RIG. METHODS: Major electronic databases (MEDLINE, Embase, Scopus, and Cochrane library) were queried for comparative studies on the two insertion techniques of gastrostomy among adults with swallowing disturbance. The primary outcome was the 30-day mortality rate after gastrostomy insertion. Forest and funnel plots were generated for outcomes using STATA version 14.0. RESULTS: Fifteen studies (n=2,183) met the inclusion criteria. PEG was associated with a lower risk of 30-day mortality after tube placement compared with RIG (odds ratio, 0.60; 95% confidence interval [CI], 0.38–0.94; P=0.026). The pooled prevalence of 30-day mortality of PEG was 5.5% (95% CI, 4.0%–6.9%) and that of RIG was 10.5% (95% CI, 6.8%–14.3%). No publication bias was noted. CONCLUSIONS: The present meta-analysis demonstrated that PEG is associated with a lower probability of 30-day mortality compared to RIG, suggesting that PEG should be considered as the first choice for long-term enteral tube feeding. Further prospective randomized studies are needed to evaluate and compare the safety of these two different methods of gastrostomy.

Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

BACKGROUND/AIMS: A percutaneous gastrostomy can be placed either endoscopically (percutaneous endoscopic gastrostomy, PEG) or radiologically (radiologically-inserted gastrostomy, RIG). However, there is no consistent evidence of the safety and efficacy of PEG compared to RIG. Recently, 30-day mortality has become considered as the most important surrogate index for evaluating the safety and efficacy of percutaneous gastrostomy. The aim of this meta-analysis was to compare the 30-day mortality rates between PEG and RIG. METHODS: Major electronic databases (MEDLINE, Embase, Scopus, and Cochrane library) were queried for comparative studies on the two insertion techniques of gastrostomy among adults with swallowing disturbance. The primary outcome was the 30-day mortality rate after gastrostomy insertion. Forest and funnel plots were generated for outcomes using STATA version 14.0. RESULTS: Fifteen studies (n=2,183) met the inclusion criteria. PEG was associated with a lower risk of 30-day mortality after tube placement compared with RIG (odds ratio, 0.60; 95% confidence interval [CI], 0.38–0.94; P=0.026). The pooled prevalence of 30-day mortality of PEG was 5.5% (95% CI, 4.0%–6.9%) and that of RIG was 10.5% (95% CI, 6.8%–14.3%). No publication bias was noted. CONCLUSIONS: The present meta-analysis demonstrated that PEG is associated with a lower probability of 30-day mortality compared to RIG, suggesting that PEG should be considered as the first choice for long-term enteral tube feeding. Further prospective randomized studies are needed to evaluate and compare the safety of these two different methods of gastrostomy.

Detailed Distribution of Liver Enzymes according to Gender, Age, and Body Mass Index in Health Check-up Subjects / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to examine the distribution of range of liver enzymes according to age and BMI in each gender using large-scale data. METHODS: Data were gathered from 65,715 subjects who underwent a routine health check-up and did not have HBsAg and anti-HCV. Boxplot analysis was used to examine the distribution of range of liver enzymes according to age and BMI in each gender. Multivariate linear regression analysis was performed for assessment of the association of liver enzymes with age and BMI, and to determine whether the range of liver enzymes was affected by risk factors for metabolic syndrome in each gender. RESULTS: ALT, AST, and GGT levels showed significant association with BMI in both male and female after adjusting for age. The range of ALT, AST, and GGT levels varied more widely according to the increase in BMI in males than in females, and this finding was more prominent in younger subjects than in older subjects. All risk factors for metabolic syndrome were shown to affect liver enzyme levels in male subjects. However, although most risk factors for metabolic syndrome affected liver enzyme levels, there might be weak or no effect of fasting hyperglycemia on AST, and low serum HDL-cholesterol level on GGT in female subjects. CONCLUSIONS: Age, BMI, and other risk factors for metabolic syndrome had a significant effect on the distribution of range of liver enzymes in each gender, even in this study conducted from Korean health checkup subjects.

Status of Primary Liver Cancer Found through Routine Health Check-up

This study aimed to investigate the status of primary liver cancers found through a routine health check-up. The data of subjects who were diagnosed with primary liver cancer for the first time through a routine health check-up during a period of 8-yr were analyzed. Primary liver cancers were detected for the first time in 34 subjects among 91,219 routine health check-up subjects. Only 11.8% of primary liver cancer subjects had been under previous surveillance. Of them, 55.8% were positive for HBsAg, 17.7% were positive for anti-HCV, and 8.8% were heavy alcohol comsumers. However, 17.7% of the subjects were neither heavy alcohol consumers nor positive for both HBsAg and anti-HCV. Of the subjects, 50.0% had a single nodular tumor, 23.5% had multi-nodular tumors, and 26.5% had an infiltrative tumor. A routine health check-up may provide beneficial opportunities to detect a liver cancer in a very early stage. It is beneficial to start surveillance in high-risk subjects for liver cancer or to detect any liver cancer in subjects without risk factors of chronic viral hepatitis or heavy alcohol consumption.

A Study of Esophageal Cancer Detected by Screening Upper Endoscopy for a Routine Health Check-up

BACKGROUND/AIMS: This study was performed to evaluate the extent, diagnostic and therapeutic results of esophageal cancer found by screening upper endoscopy during a routine health check-up. MATERIALS AND METHODS: Among 88,575 subjects presenting for screening upper endoscopy between 2003 and 2011, those with esophageal cancer were extracted using the pathologic results of upper endoscopic biopsy from the esophagus as the final subjects for this study. Wilcoxon rank sum test or Fisher's exact test were used to test statistical differences. RESULTS: A total of 9 patients with esophageal cancer were detected. Seven patients had squamous cell carcinoma and 2 had adenocarcinoma. A depressed mucosal lesion about 1.0 cm size was the most common endoscopic finding of squamous cell carcinoma, however, a polypoid lesion in association with reflux esophagitis was the major finding of adenocarcinoma. Therapeutic data were available in 7 patients. Five squamous cell carcinoma patients were at stage IA, 3 were treated by endoscopic submucosal dissection and 2 by laparoscopic total esophagectomy. Two adenocarcinoma patients, of stage IIB and IIIA respectively, were treated by Ivor Lewis operation. CONCLUSIONS: Our data suggest that screening upper endoscopy during a routine health check-up may enable early detection of esophageal cancer. However, more effort should be given to detect esophageal adenocarcinoma in an earlier stage.

Seroprevalence of Hepatitis A and Associated Socioeconomic Factors in Young Healthy Korean Adults

BACKGROUND/AIMS: An epidemiologic shift of hepatitis A virus (HAV) seroprevalence is expected due to an improvement in socioeconomic status in young adults in Korea. We investigated the age-specific seroprevalence and socioeconomic factors associated with HAV seropositivity in young, healthy Korean adults. METHODS: Between March 2009 and February 2010, a total of 5,051 persons from 20 to 49 years of age presenting for a health check-up were included and responded to a questionaire. The seroprevalence of HAV was investigated by measuring immunoglobulin G (IgG) anti-HAV. A total of 984 pairs of cases and age- and sex-matched controls were analyzed for associated socioeconomic factors. RESULTS: The prevalence of seropositive HAV was 6.2% in the 20 to 29 age range, 33.1% in the 30 to 39 range and 82.4% in the 40 to 49 range (p<0.001). There were no significant differences in any group according to gender. A multivariate analysis for paired cases indicated that HAV seropositivity was significantly higher in the low monthly income (below five million won, approximately 4,300 dollars) group and the Helicobacter pylori (H. pylori)-positive group (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.27-2.14; p<0.001; OR, 1.45; 95% CI, 1.19-1.76; p<0.001, respectively). CONCLUSIONS: HAV seropositivity in young adults presenting for a health checkup appears to be decreasing, and the prevalence was significantly higher in the low monthly income group and the H. pylori-positive group.

Metastatic hepatocellular carcinoma presenting as facial nerve palsy and facial pain / 대한간학회지

Facial nerve palsy due to temporal bone metastasis of hepatocellular carcinoma (HCC) has rarely been reported. We experienced a rare case of temporal bone metastasis of HCC that initially presented as facial nerve palsy and was diagnosed by surgical biopsy. This patient also discovered for the first time that he had chronic hepatitis B and C infections due to this facial nerve palsy. Radiation therapy greatly relieved the facial pain and facial nerve palsy. This report suggests that hepatologists should consider metastatic HCC as a rare but possible cause of new-onset cranial neuropathy in patients with chronic viral hepatitis.

Cavernous Transformation of the Portal Vein with Gastric Varix / 대한내과학회지

No abstract available.

Hepatocellular carcinoma with colon metastasis / 대한내과학회지

No abstract available.

A Case of Esophageal Obstruction Caused by an Ingested Canine Gallbladder / 대한소화기내시경학회지

Endoscopic intervention is a very important and effective tool for evaluating and treating an esophageal foreign body. The size of a cystic foreign body filled with liquid can be reduced by needle puncture and fluid spillage. We report a rare case of an acute total obstruction of the esophagus by an ingested canine gallbladder that was removed by endoscopic intervention.

Papillary gastric adenocarcinoma / 대한내과학회지

No abstract available.

Helicobacter pylori Infection and Pathologic Findings in Bile Reflux Gastritis / 대한소화기내시경학회지

BACKGROUND/AIMS: The role of Helicobacter pylori in bile reflux gastritis (BRG) is uncertain. We show the role of H. pylori and pathology in BRG. METHODS: Thirty seven patients, including 5 patients who had undergone subtotal gastrectomy, were diagnosed with BRG by gastroscopic findings of bile-stained mucosa with hyperemia/ erosions. We measured total bile acid (TBA) concentration and compared the H. pylori positivity between BRG patients and 70 non-BRG patients. We showed how often we could see the pathologic findings of reactive gastritis in BRG and compared the grade of lymphoplasma cell and neutrophil infiltration between H. pylori positive and negative group in BRG. RESULTS: TBA concentration of 10 patients was 7,376.7+/-5,482.6micro mol/L. H. pylori positive rate of BRG was 45.9% and that of non-BRG was 70% (p=0.015). The gastric pit elongation and tortuosity were found only in 3 cases with gastric surgery. The grade of lymphoplasma cell and neutrophil infiltration was 2.41+/-0.51 and 1.88+/-0.86 in H. pylori positive BRG and 1.55+/-0.69 and 0.55+/-0.76 in H. pylori negative BRG, respectively (p<0.001). CONCLUSIONS: H. pylori infection in BRG was lower than that in non-BRG. The gastric pit elongation and tortuosity of BRG were not seen often. The lymphoplasma cell and neutrophil infiltration were relatively sparse in H. pylori negative BRG.

A Case of Esophageal Intramural Pseudodiverticulosis / 대한소화기내시경학회지

Esophageal intramural pseudodiverticulosis is a rare disease characterized by multiple, flask-shaped outpouchings in the esophageal wall. These pseudodiverticula represent abnormally dilated excretory ducts of esophageal submucosal gland, which cause is unknown. The most common symptom is dysphagia associated with esophageal stricture. Frequently associated diseases were gastroesophageal reflux disease, diabetes mellitus, candida esophagitis, and chronic alcoholism. We have experienced a patient with dysphagia and anemia, who was diagnosed as esophageal stricture with intramural pseudodiverticulosis and pancreatic pseudoaneurysm. He was treated with esophageal bougienage for the esophageal stricture and transcatheter embolization for pancreatic pseudoaneurysm. This may be the first case of esophageal intramural pseudodiverticulosis reported in Korea.