The Clinical Significance of Specialized Intestinal Metaplasia in the Diagnosis of Barrett's Esophagus: Nationwide Prospective Multicenter Study

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.

The Distribution of Endoscopic Gastritis in 25,536 Heath Check-up Subjects in Korea

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.

The Distribution of Endoscopic Gastritis in 25,536 Heath Check-up Subjects in Korea

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.

Is Metabolic Syndrome One of the Risk Factors for Gallbladder Polyps Found by Ultrasonography during Health Screening?

BACKGROUND/AIMS: We conducted this study to identify the risk factors for finding gallbladder polyps (GBP) in Korean subjects during health screening, and to determine the nature of the association between the presence of metabolic syndrome (MS) and the development of GBP. METHODS: A total of 1,523 subjects were enrolled, comprising 264 with GBP (81 women and 183 men) and 1,259 controls (696 women and 563 men with normal GB). Body mass index (BMI), waist circumference (WC), blood pressure (BP), insulin, fasting blood sugar (FBS), lipids, liver enzymes, hepatitis B antigens (HBs Ag), and hepatitis C antibodies (HCV Ab) were measured. MS was considered to be present when three or more of the NCEP-ATPIII (National Cholesterol Education Program-Adult Treatment Panel III) criteria were satisfied. Insulin resistance was calculated by homeostasis model assessment of insulin resistance (HOMA-IR). Independent risk factors were analyzed by logistic regression analysis. RESULTS: Univariate analysis revealed that the risk factors for GBP were age, sex, WC, smoking history, BP, BMI, FBS, serum lipids, HOMA-IR score, and MS. Multivariate logistic regression analysis revealed that the risk factors for GBP were presence of MS (Odds Ratio (OR)=2.35, 95%Confidence Interval (CI)=1.53-3.60), being male (OR=2.34, 95%CI=1.72-3.18), HOMA-IR score>2.5 (OR=1.64, 95%CI=1.19-2.26), and higher WC (OR=1.4, 95%CI=1.05-1.88). MS was present in 20.8% and 5.9% of GBP patients and controls, respectively, and was the highest risk factor for GBP. CONCLUSIONS: MS, male, insulin resistance, and abdominal obesity are probably risk factors for GBP, with MS appearing to be strongly associated with GBP in Koreans.

Features of Gastric Neoplasm Detected during the Screening Examination

BACKGROUND/AIMS: Gastric cancer is the leading malignancy in Korea and early detection through the health screening seems to be important. The aims of this study were to investigate the features of gastric neoplasms detected during screening, and to figure out the risk factors of these lesions. METHODS: From October 2003 to September 2005, subjects who visited Seoul National University Hospital Healthcare System Gangnam Center for health check-up were included in the study. The program included a questionnaire and tests including anti-Helicobacter pylori (H. pylori) antibody, esophagogastroduodenoscopy or double contrast upper gastrointestinal study. To figure out the risk factors, an age and gender-matched, four-fold sized control group was selected from the subjects. RESULTS: Of 25, 432 subjects, 122 cases of gastric neoplasms were detected including 61 adenocarcinoma (45 early gastric cancers), 53 adenoma, 7 mucosa-associated lymphoid tissue lymphoma, and one metastatic cancer. There was no significant statistical difference in basal characteristics of the subjects between gastric adenocarcinoma and adenoma. When comparing with the control group those without gastric neoplasms, smoking history, family history of stomach cancer, and H. pylori seropositivity were found to be significant risk factors for gastric neoplasms. Metabolic syndrome was more prevalent in adenoma than in the control (p<0.05). CONCLUSIONS: The health screening may be beneficial in early detection of gastric cancer. In addition, metabolic syndrome might be related with gastric adenoma.

A case of cytomegalovirus colitis in an immunocompetent adult presenting as pancolitis / 대한내과학회지

CMV is common cause of life-threatening opportunistic viral infection in immunocompromised patients, especially in transplant recipients and those who are infected with HIV. Although CMV infection is generally asymptomatic in healthy adults, CMV colitis can occur in immunocompetent adults. While the right colon is the most common site of gastrointestinal CMV infection, it is extremely rare for it to involve the whole colon. We report a rare case of cytomegalovirus (CMV) colitis in an immunocompetent adult presenting as pancolitis. The usual course of gastrointestinal CMV infection is self limited in an immunocompetent adult, but our case revealed that conservative treatment was not enough, and the administration of ganciclovir was essential for the improvement of disease.

Preoperatively Diagnosed Asymptomatic Early Extrahepatic Bile Duct Cancer / 대한소화기내시경학회지

Cholangiocarcinoma is usually diagnosed at the advanced stage because early symptoms and signs are relatively infrequent. The preoperative diagnosis of early extrahepatic bile duct cancer in common bile duct is uncommon. Also, an extrahepatic bile duct cancer arising from the lower portion of the common bile duct is usually papillary and rarely nodular or sclerosing. We decribe a case, preoperatively diagnosed as early extrahepatic bile duct cancer in lower portion of common bile duct, nodular type on endoscopic retrograde cholangiography. It was incidentally detected by the slight elevation of gamma-glutamyl transpeptidase without any symptoms. An endoscopic retrograde cholangiography showed abrupt narrowing of the intrapancreatic portion of the common bile duct with irregular and nodular filling defect. The lesion was confined to mucosa on the endoscopic ultrasonography. This patient was diagnosed as early extrahepatic bile duct cancer and underwent Whipple's operation. A histopathologic examination of resected specimen revealed to be moderately differentiated adenocarcinoma at stage 1 (T1N0Mo) in the extrahepatic bile duct.

Acute Pancreatitis due to Hypertriglyceridemia: Report of 2 Cases / 대한소화기학회지

Hypertriglyceridemia (HTG) is a rare but well known cause of acute pancreatitis (AP), which can be a life- threatening complication if the degree of HTG is severe enough. It might be primary in origin or secondary to alcohol abuse, diabetes mellitus, pregnancy, or drugs. A serum triglyceride (TG) level of more than 1,000 to 2,000 mg/dL in patients with type I, IV, or V hyperlipidemia (Fredrickson's classification) is the identifiable risk factor. HTG-induced AP typically presents as an episode of AP or recurrent AP. The clinical course of HTG-induced AP is not different from other causes. Routine management of HTG-induced AP should be similar to other causes. A thorough family history of lipid abnormalities should be obtained, and an attempt to identify secondary causes should be made. The mainstay of treatment includes dietary restriction of fatty meal and lipid-lowering medications (mainly fibric acid derivatives). Although there are limited experiences with plasmapheresis, lipid apheresis, heparinization and insulin application, these can support the treatment of HTG- induced AP. We report two cases of HTG-induced AP which were successfully treated by plasmapheresis.

Prospective Comparing the Efficacy of CT Colonography and Colonoscopy for Detecting Colorectal Adenomatous Polyp in Asymptomatic Adults / 대한소화기내시경학회지

BACKGROUND/AIMS: The purpose of this study is to evaluate the efficacy of CT colonography (CTC) in comparison with colonoscopy for the detection of colorectal adenomatous polyp in asymptomatic adults. METHODS: A total 208 asymptomatic adults underwent successive CTC and colonoscopy, on the same day. RESULTS: On the analysis of adenomatous polyps per subject, the sensitivity of CTC was 90% (9/10) in case of polyps > or =10 mm in size, and 67.7% (21/31) in case of polyps > or =6 mm in size. Those values of colonoscopy were 100% and 93.5%, respectively. The per-patient specificity of CTC was 98.0% (194/198) in case of polyps > or =10 mm in size and 88.1% (156/177) in case of polyps > or =6 mm in size. CTC missed 4 (3 flat adenomas and, 1 sessile adenoma) out of 17 adenomatous polyps > or =10 mm in size in 2 subjects. CONCLUSIONS: In asymptomatic adults, the sensitivity of CTC for detecting adenomatous polyps was lower than that of colonoscopy, particularly for the small lesions below 10 mm in size, and also for the flat adenomas > or = 10 mm in size. However, CTC showed a high sensitivity and specificity for detecting the subjects with clinically important colorectal adenomatous polyps > or = 10 mm in size. These results suggest that CTC has potential as a screening method for colorectal neoplasm.

Outbreak of Hepatitis by Orientia tsutsugamushi in the Early Years of the New Millenium / 대한간학회지

BACKGROUND/AIMS: Orientia -tsutsugamushi infection is an acute febrile disease due to the accidental transmission through human skin of forest dwelling vector Leptotrombidium larva. The authors observed liver dysfunctions in patients diagnosed with tsutsugamushi disease (Scrub typhus) in the past 3 years and report the data in the hope of bringing attention to this disease in the differential diagnosis of autumn-season hepatitis, especially of non-A, non-B and non-C hepatitis. METHODS: Medical records of 22 patients diagnosed with tsutsugamushi disease by the hemagglutinin method between October 2000 and November 2002 were reviewed. RESULTS: Female gender was dominant in the ratio of 3.4:1. Mean age was 56.4 +/- 2.6. Admission was between 23rd September and 15th November with the peak between mid October and early November. Fever, being the most common symptom, was observed in 21 cases, myalgia in 13, arthralgia in 12, chills in 6, and skin rash in 6. An incubation period of 7-9 days was most common (10 cases), 13-15 days (4), 10-12 days (3), within 3 days (3), and 4-6 days (2). Average ALT, AST and GGTP were increased to 93.2 +/- 17.3 IU/L (18 +/- 345 IU/L), 92.5 +/- 11.7 IU/L (34-255 IU/L) and 132.2 +/- 14.5 IU/L (19-251 IU/L), respectively, but total bilirubin was normal. All the patients improved with doxycycline therapy. CONCLUSIONS: Since it usually shows liver dysfunction, it is important to take Orientia tsutsugamushi into consideration in differential diagnosis of autumn-season, febrile hepatic disease.

Colonic Transit Time in Patient with Liver Cirrhosis / 대한소화기학회지

BACKGROUND/AIMS: The colonic transit time in patients with liver cirrhosis has not been studied extensively in South Korea. Thus, the authors investigated the differences of colonic transit time between cirrhotic patients and normal controls with attention to factors that affect this change. METHODS: Fifteen cirrhotic patients and 15 controls were included in this study. To exclude any organic diseases, colonoscopy was preceded. The colonic transit time was measured by taking plain abdominal films on the 4th and 7th days after ingestion of radiographic non-absorbable colon markers for 3 days. RESULTS: The colonic transit time was 10.7 +/- 2.6 hours and 24.0 +/- 4.1 hours for cirrhotic patients and controls, respectively, indicating that the transit time in cirrhotic patients is much faster (p<0.05). The transit time for each segment of the colon was also measured. For the ascending colon, average transit time of the cirrhotic patients and controls were 5.60 +/- 1.93 and 6.88 +/- 1.77 hours respectively. For the descending colon, those were 2.80 +/- 1.04 and 10.80 +/- 2.59 hours (p<0.05), while those in the rectosigimoid portion were 2.32 +/- 0.81 and 4.96 +/- 1.19 hours, respectively. These results indicated that a significant difference is present in the descending colon. Additionally, the transit time is correlated with age and albumin level (B=0.760, p<0.05 and B=7.498, p<0.01, respectively). CONCLUSIONS: The colonic transit time of cirrhotic patients is faster than that of control, especially in the descending colon.

A Case of Henoch-Schonlein Purpura with Portal Vein and Mesenteric Vein Thrombosis / 대한혈액학회지

Henoch-Schonlein purpura is an immunologically mediated systemic leukocytoclastic vasculitis of small vessels that is characterized by symmetric nontraumatic, nonthrombocytopenic, painless palpable purpura on the lower extremities and buttock, arthralgias on usually the knees and ankles, gastrointestinal symptoms and glomerulonephritis. Although the jejunum and ileum are most frequently affected, any portion of gastrointestinal tracts may be involved. Generally, gastrointestinal manifestations of Henoch-Schonlein purpura are the edematous wall of involved bowel, submucosal hemorrhage and erosion. We experienced a 56-year-old man with Henoch-Schonlein purpura who initially presented acute abdominal pain with portal vein and superior mesenteric vein thrombosis.

A Case of Fulminant Hepatic Failure in Wilson's Disease Combined with Systemic Lupus Erythematosus / 대한간학회지

Patients with systemic lupus erythematosus (SLE) have a chance of developing liver involvement in their lifetime. The main cause of liver involvement in SLE patients is previous treatment with hepatotoxic drugs or hepatotropic viral hepatitis. Wilson's disease is a hereditary disorder and is usually diagnosed in patients presenting either neuropsychiatric disorders or manifestations related to chronic liver disease. Fulminant hepatic failure as the initial manifestation of Wilson's disease is rare. The relationship between systemic lupus erythematosus and Wilson's disease has not been established. We report a case of a 12-year-old girl with SLE who presented fulminant hepatic failure as an initial manifestation of Wilson's disease. The diagnosis was established with decreased serum ceruloplasmin level and the presence of Kayser-Fleischer ring. We treated with repeated plasma exchange. Despite repeated plasma exchange she died of multi-organ failure on the 16th hospital day. Considering this case, Wilson's disease should be considered as a cause of fulminant hepatic failure, especially in juvenile age cases.

Comparison of beta-adrenergic receptor in human placenta of early and term pregnancy / 대한산부인과학회잡지

No abstract available.