Long-term effect after Helicobacter pylori eradication in patients with peptic ulcer disease : A retrospective study / 대한내과학회지

BACKGROUND: Eradication therapy for H. pylori infection is known to decrease the recurrence rate of peptic ulcer disease. The aim of this study was to evaluate longterm effect of H. pylori eradication on the recurrence of peptic ulcer disease and the reinfection rate after treatment in Korea. METHODS: Between July 1996 and February 1997, 763 patients who were diagnosed peptic ulcer diseases and H. pylori infection after upper endoscopies in Soonchunhyang university hospital. Among those patients, we reviewed 32 patients who achieved eradication of H. pylori after eradication therapy and could be followed for up to 4 years by (13)C-urea breath test or endoscopy. RESULTS: The mean age of the patients was 51.7 years (range: 29~68). Nine patients had gastric ulcer, 12 had duodenal ulcer and 11 had duodenal and gastric ulcer. An annual reinfection rate of H. pylori was 1.6% in our study. After H. pylori eradication, recurrence of peptic ulcer was detected in three patients (9.4%). CONCLUSION: In our study, the reinfection rate was similar to rates observed in developed countries. H. pylori eradication was effective for preventing recurrent peptic ulcers.

A case of esophageal bezoar consisted with candidiasis / 대한내과학회지

Bezoars are persistent concretions of indigestible matter, usually seen in the stomach. But very rarely have bezoars been reported in the esophagus.. Most esophageal bezoars are either phytobezoars or medication bezoars occuring usually in the middle aged & elderly associated with underlying anatomical or functional abnormalities of esophagus. A variety of techniques has been developed recently in diagnostic and therapeutic endoscopy. So endoscopic management is safe and successful in most cases those required surgical management. We experienced an esophageal bezoar consisted with esophageal candidiasis in a patient who underwent esophago-gastric anastomosis and proximal gastrectomy due to early gastric cancer. The bezoar was removed by endoscopy and the esophago-gastric stenosis was treated with balloon dilator without any significant complication.

2 Cases of Endoscopic Ligation Therapy of a Dieulafoy Ulcer / 대한소화기내시경학회지

A dieulafoy ulcer is rarely recognized but is not an uncommon cause of massive, recurrent and frequently fatal gastrointestinal bleeding resulting from the erosion of an unusually large submucosal artery. Although the lesion has been predominantly found in the proximal stomach, it has also been detected throughout the gastrointestinal tract. Diagnosis can be made by observation of protruding and eroded arteries with pulsatile bleeding, or through detection of an adherent thrombus using an endoscopy. In the past, surgical intervention was believed to be the best treatment, but currently, therapeutic endoscopy is more favored, due to its recent success in achieving permanent hemostasis. We experienced 2 cases of Dieulafoy's ulcer of the stomach. Endoscopic ligations using an O ring were performed successfully.

A Case of Esophageal Perforation by an Endoscopic Biopsy / 대한소화기내시경학회지

The esophagus or stomach can be perforated during diagnostic upper endoscopy in 0.03 to 0.1 percent. Instrumentation injury, as a whole, is probably the most common single cause of all cases of esophageal perforation. Most of the esophageal perforation result from either therapeutic maneuvers(dilation, sclerotherapy, foreign-body removal etc.) or underlying esophageal lesion(such as strictures or diverticular or neoplasm). Endoscopic perforation of the esophagus may be obvious immediately or within a few hours. Cervical pain, subcutaneous emphysema, fever, tachycardia, and characteristic radiographic appearances make the diagnosis easy, but some distal esophageal injuries are subtler, An immediate esophagogram should be obtained if peirforation is suspected. To select an appropriate course of management, precise delineation of location and the extent of perforation is necessary. The esophageal perforation can be managed conservatively by close observation, esophageal rest, and antibiotic coverage, but the mortality rate of medical treatment is near 12%. Causes of death are sepsis and multisystem organ failure. So we report a case of esophageal perforation by an endoscopic biopsy.

Two Cases of Needle and Toothpick Stuck in the Stomach / 대한소화기내시경학회지

Foreign bodies in the stomach are usually ingested by children under 5 years of age, persons with dentures, alcoholics, mentally disturbed individuals or prisoners with a purpose of secondary gain. Many patients will be asymptomatic and will be brought in by parents with a history of having swallowed something. The ingested foreign bodies are mainly coins, particles of metals, fish bones and etc. A needle or a toothpick in the stomach has been rarely reported in an adult.. We present two cases of patients: one case of patient with needle stuck in the stomach, who swallowed for the purpose of secondary gain, and the other case of patient with toothpick stuck in the stomach, who did not realize having swallowed it. A 23-year-old man, prisoner, was admitted to hospital due to epigastric pain after ingestion of a needle. Endoscopy showed a black needle, 1.2cm long stuck at the prepyloric antrum. It was removed by the endoscopic biopsy forceps through the overtube used in endoscopic variceal ligation and proved to be a needle with a length of 4.9 cm and a diameter of 0.1 cm. A 58-year-old woman developed an acute onset of hematemesis and epigastralgia, and presented to the emergency room. On admission, her blood pressure was 60/40 mmHg. An emergency endoscopy showed a yellowish, thin, stiff material 3.5cm long stuck at the greater curvature of the antrum with meat materials. It was removed by the above method and proved to an wooden tooth pick with a length of 6.5 cm and a diameter of 0.2 cm. No active bleeding was noted from the removed site. She did not realized she had swallowed the toothpick. She was discharged without complication.