Diagnostic Use of Endoscopic Ultrasonography in the Evaluation of Common Bile Duct Dilatation / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to assess the diagnostic use of endoscopic ultrasonograpy (EUS) in detecting the cause of common bile duct (CBD) dilatation in patients in whom abdominal ultrasonography or abdominal CT scan could not identify the cause of dilatation. METHODS: Thirty-seven patients (23 men, 14 women, mean age 62.2 years) with uncertain causes of CBD dilatation on abdominal sonogram and CT scan between October 1999 and November 2003 were enrolled. All patients were evaluated by EUS and endoscopic retrograde cholangiopancreatography (ERCP). Final diagnosis were determined by ERCP, surgical exploration and clinical follow-up. RESULTS: The following diagnosis were made by EUS: choledocholithiasis in 11 patients, CBD dilatation only in 12, benign stricture of distal CBD in 8, periampullary tumor in 6. The definitive diagnosis of choledocholithiasis (n=11), benign stricture of distal CBD (n=10), ampullary tumor (n= 5) were determined by ERCP with or without sphincterotomy and surgical exploration. EUS provided the accurate explanation for CBD dilatation in 32 of the 37 patients (86%). CONCLUSIONS: When the diagnosis of biliary obstruction remains obscure on abdominal sonography or CT scan, EUS may be useful.

Ulcerative Colitis is Associated with Novel Polymorphisms in the Promoter Region of MIP-3alpha/CCL20 Gene

BACKGROUND: We examined global gene expression profiles of peripheral blood mononuclear cells (PBMCs) in patients with ulcerative colitis (UC), and tested whether the identified genes with the altered expression might be associated with susceptibility to UC. METHODS: PBMCs from 8 UC and 8 normal healthy (NH) volunteers were collected, and total RNAs were subjected to the human 8.0K cDNA chip for the microarray analysis. Real time-PCR (RT-PCR) was performed to verify the results of microarray. One hundred forty UC patients and 300 NH controls were recruited for single nucleotide polymorphism (SNP) analysis. RESULTS: Twenty-five immune function-related genes with over 2-fold expression were identified. Of these genes, two chemokines, namely, CXCL1 and CCL20, were selected because of their potential importance in the evocation of host innate and adaptive immunity. Four SNPs were identified in the promoter and coding regions of CXCL1, while there was no significant difference between all patients with UC and controls in their polymorphisms, except minor association at g.57A< G (rs2071425, p=0.02). On the other hand, among three novel and one known SNPs identified in the promoter region of CCL20, g.-1,706 G< A (p=0.000000055), g.-1,458 G< A (p=0.0048), and g.-962C< A (p=0.0006) were found to be significantly associated with the susceptibility of UC. CONCLUSION: Altered gene expression in mononuclear cells may contribute to IBD pathogenesis. Although the findings need to be confirmed in other populations with larger numbers of patients, the current results demonstrated that polymorphisms in the promoter region of CCL20 are positively associated with the development of UC.

Genotypes of Hepatitis B Virus on Jeju Island / 대한간학회지

BACKGROUND/AIMS: Hepatitis B virus (HBV) was classified into 8 genotypes by a sequence divergence in the entire genome designated from A to H. HBV genotypes have distinct geographic distributions. Recently, HBV genotypes have been partially found as influencing the clinical manifestation of chronic liver disease in hosts. In Korea, the distribution of HBV genotypes remains unclear. The aim of this study was to evaluate the prevalence of the HBV genotype on Jeju Island. METHODS: Hepatitis B virus genotypes were evaluated among 107 hepatitis B carriers residing on Jeju Island. We used single PCR and multiplex-PCR assay with genotype-specific primer pairs for HBV genotypes A-F for the genotyping. RESULTS: 1. Fifty nine samples (55%) were positive for HBV DNA. The positivity was different according to the pattern of HBeAg/ anti-HBe expression, as -/-; 2/3 (66.7%), -/+; 30/73 (30%), +/-; 24/28 (85.7%) and +/+; 3/3 (100%). 2. In the single primer set of genotype-specific PCR, 59 samples (100%) were detected as genotype C and 2 (3%) were also detected as genotype A and B. 3. In multiplex-PCR, 58 samples (98%) were detected as genotype C and only one (2%) as a mixed pattern of genotype B and C. 4. When the PCR products were amplified with universal sense and genotype specific anti-sense from one genotype A, one B, and 2 C, all were included in genotype C. CONCLUSIONS: These results suggest that on Jeju Island, almost all HBV genotypes are C.

Relevancy between Liver Injury, Serum HBV-DNA, and Intrahepatic HBcAg in Young Male Chronic HBV Carriers / 대한소화기학회지

BACKGROUND/AIMS: Although the viral load is correlated with HBcAg, liver injury was not correlated to viral load in HBeAg positive patient. We aimed to study the inter-relationship of clinical parameters such as the level of HBV-DNA, the level of aminotransferase, intrahepatic expression of HBcAg and severity of histological liver damage in the young male chronic HBV carriers according to HBeAg status. METHODS: The study group included 85 young male patients (mean age: 19.8) with biopsy-proven chronic hepatitis B (HBeAg-positive group: n=60, HBeAg-negative group: n=25). RESUTLS: Serum levels of HBV-DNA and the expression of intrahepatic HBcAg in the HBeAg-positive group were significantly higher than in the HBeAg-negative (p<0.001), but fibrosis score was lower (p<0.01). Serum levels of HBV-DNA positively correlated with lobular activity, portal/periportal activity, biochemical activities in the HBeAg-negative group but negatively correlated in the HBeAg-positive group. There were no significant differences in histological activity according to the pattern of expression of intrahepatic HBcAg in both groups. The lobular activity correlated positively with biochemical activity in both groups, and portal/periportal activity correlated with biochemical activity only in the HBeAg-positive group. CONCLUSIONS: There are close correlations among liver injury, intrahepatic expression of HBcAg, and detectable HBV-DNA in the young male chronic HBV carriers with HBeAg-negativity, but in the HBeAg-positive group, the correlations are diversified.

Hemoperitoneum Induced by Gastrointestinal Stromal Tumor Rupture of the Stomach / 대한소화기내시경학회지

Gastrointestinal stromal tumors (GIST) form a group of uncommon neoplasms originated from the pleuripotential mesenchymal cell. There is no final conclusion about accurate diagnosis and prognostic factors of GIST. Clinical presentation is not specific and intraperitoneal bleeding is a very rare complication. We report a case of a malignant GIST complicated by intraperitoneal hemorrhage, which was diagnosed by abdominal CT and EUS before operation. A subtotal gastrectomy was perfomed without complication. The patient is still alive without recurrence.

Hemoperitoneum Induced by Gastrointestinal Stromal Tumor Rupture of the Stomach / 대한소화기내시경학회지

Gastrointestinal stromal tumors (GIST) form a group of uncommon neoplasms originated from the pleuripotential mesenchymal cell. There is no final conclusion about accurate diagnosis and prognostic factors of GIST. Clinical presentation is not specific and intraperitoneal bleeding is a very rare complication. We report a case of a malignant GIST complicated by intraperitoneal hemorrhage, which was diagnosed by abdominal CT and EUS before operation. A subtotal gastrectomy was perfomed without complication. The patient is still alive without recurrence.

The Effect of Itopride, a New Prokinetic, on Acid Reflux Symptoms and Variables in Patients with GERD / 대한소화관운동학회지

BACKGROUND/AIMS: Itopride is a newly developed prokinetic agent enhancing gastric motility through both antidopaminergic and anti-acetylcholinesterase actions. The importance of esophageal motor dysfunction in the pathogenesis of gastro-esophageal reflux disease (GERD) makes it interesting to examine the effect of itopride on esophageal acid exposure. METHODS: The effect of itopride on esophageal 24-hour acid reflux variables was studied in 26 patients with GERD symptoms, pre-entry total acid exposure time (pH<4) of more than 5% and mild esophagitis (Savary-Miller grade I, II) by endoscopy. Ambulatory 24-hour pH monitoring and symptom assessment were performed after treatment with itopride 50 mg or 100 mg t.i.d for 4 weeks by a randomization allocation schedule with an open label. RESULTS: In both itopride groups, total symptom scores were decreased after treatment significantly. Itopride 300 mg was significantly more effective than 150 mg in decreasing the total time and total percent time of intraesophageal pH below 4, and DeMeester score. Consequently, no serious adverse effects were reported after administration in both groups. CONCLUSIONS: Itopride 100 mg t.i.d is effective to decrease pathologic reflux in patients with GERD. Therefore, it has a therapeutic potential for this diseases.

A case of minimal change glomerulopathy without interstitial nephritis induced by non-opiate analgesics / 대한내과학회지

The use of nonsteroidal antiinflammatory drugs (NSAIDs) can be complicated by severe forms of renal dysfunction. These include fluid and electrolyte abnormalities, acute renal insufficiency due to alteration in renal hemodynamics, or interstitial nephritis and proteinuria secondary to glomerular pathology, which has the histologic characteristics of minimal change glomerulopathy (MCG). While NSAID-induced nephrotic syndrome characteristically consists of MCG with interstitial nephritis, which is the most common clinical manifestation, it rarely consists of MCG without interstitial nephritis, which has been reported in a handful of patients who took fenoprofen, ibuprofen, sulindac, diclofenac, or zomepirac. We experienced a 66-year-old female patient who presented with low serum albumin, proteinuria and generalized edema and received Geworin for about 2 year before developing symptoms. She histologically had MCG without interstitial nephritis and achieved a complete remission thirty-fifth days after discontinuing the drug. A cause-and-effect relationship of this disease to Geworin administration is strongly suggested by the resolution of the proteinuria after the drug was stopped and by no evidence of any impairment in renal function after twenty eight months of follow-up.

A Case of Idiopathic Megacolon Associated with Sigmoid Volvulus

Megacolon is an uncommon condition in which the bowel is persistently of increased diameter and it is always associated with long-standing constipation. Two main groups are recognized according to whether or not ganglia are present in the intermuscular plane of the rectal wall. Their complete absence, even along a short segment of rectum, denotes Hirschspurung's disease. If ganglia are present, the dilated bowel may be secondary to some predisposing factor such as a stricture, a congenital anorectal abnormality, a cauda equina lesion etc. In other instances, however, there may be no apparent organic reason as to why the bowel should be so dilated. This latter condition is termed "idiopathic megacolon". We report the case of one female patient with idiopathic megacolon. During medical treatment, she was complicated with a sigmoid volvulus, we performed subtotal colectomy and cecorectal anastomosis and she improved without any complication.

A Case of Gastric Schwannoma / 대한소화기내시경학회지

Most submucosal tumors of the stomach are of mesenchymal origin. Gastric schwannoma, which is a subset of mesenchymal tumors, is a rare tumor taking origin from Schwann's cells. A 61-year-old woman whose endoscopy showed a well circumscribed submucosal mass measuring 2.5 cm on the midbody of the stomach. Endosonographically, the tumor was well circumscribed, low echoic submucosal mass with cystic lesion in the 4th layer of the gastric wall. The patient underwent wedge resection. Microscopically, the cells were made up of irregular fasciculating bundles of spindle cells featured with benign nuclear atypia and peripheral lymphoid cell cuffing, involving muscularis propria. Immunohistochemical staining showed positivity for S-100 protein and the neuron-specific enolase, but were negative to CD 34, desmin and smooth muscle actin. From these findings, this tumor was diagnosed as a schwannoma.

A Case of Nutcracker Esophagus Associated with Chest Pain and Antidepressant Treatment / 대한소화관운동학회지

Nutcracker esophagus is thought to be a common cause of noncardiac chest pain although has not been clearly established, and the effective treatment is lacking. The usual forms of therapy for noncardiac chest pain by nutcracker esophagus have been directed traditionally toward reducing esophageal hypermotility and muscle tone such as nitrate and calcium channel blocker. However, the results of this treatment in the long term care of patient with esophageal symptoms have been generally disappointing and often unsatisfactory. Recently, psychosomatic aspect of esophageal motility disorder including antidepressant treatment has been accepted in the treatment of noncardiac chest pain. We report a 48 year old female with nutcracker esophagus associated chest pain by ambulatory 24 hour esophageal manometry who failed diagnosis by conventional manometry. The symptoms of chest pain, quality of life, and depression of the patient were improved after antidepressant medication.

A Case of Menetrier's Disease / 대한소화기내시경학회지

Menetrier's disease is a form of hypertrophic gastropathy occurring primarily in middle-aged males. Patients generally present clinically with dyspepsia and, on occasion, with hypoproteinemic edema and anemia. The latter feature, when combined with the radiographic appearance of the stomach in Menetrier's disease, can lend to confusion with carcinoma and malignant lymphoma. A 45-year-old male was admitted with chief complaint of epigastric dscomfort. Endoscopic examination revealed the appearance of enlarged gastric folds involving the body and fundus of the stomach with relative sparing of the antrum and endoscopic ultrasonography (EUS) reveals characteristic thickening with enhanced echogenicity of the second layer. Biopsies revealed foveolar hyperplasia with cystic dilatation of the glands, compatible with Menetrier's disease. We report a case of Menetrier's disease with brief review of literatures.