Prevalence of Extraesophageal Symptoms in Patients With Gastroesophageal Reflux Disease: A Multicenter Questionnaire-based Study in Korea

BACKGROUND/AIMS: Many patients with gastroesophageal reflux disease (GERD) also present with extraesophageal symptoms (EESs). This study sought to determine the prevalence of concomitant EESs and to evaluate quality of life (QOL) impairment in a Korean population with GERD. METHODS: This questionnaire-based study was carried out from 64 hospitals in Korea between October 2008 and March 2009. Patients with typical GERD symptoms of heartburn or acid regurgitation were recruited for study. Participants filled out questionnaire consisting of GerdQ questions and EES questions. All participants underwent endoscopy and were divided into patients with erosive reflux disease (ERD) and with non-erosive reflux disease (NERD). RESULTS: A total of 1,712 patients were included in this study. Of these, 697 (40.7%) patients had ERD and 1,015 (59.3%) NERD. The prevalence of EES was 90.3%. The most prevalent EES was epigastric burning (73.2%), followed by globus (51.8%), chest pain (48.4%), cough (32.0%), hoarseness (24.2%) and wheezing (17.3%). Individual EES was more prevalent in patients with ERD than in those with NERD. Regarding QOL, 701 patients (41.0%) had sleep disturbance and 676 (37.7%) had taken additional over-the-counter medication for heartburn and/or regurgitation, which were more prevalent in patients with ERD than in those with NERD (49.5% vs. 35.1% and 45.8% vs. 32.2%, respectively; all P < 0.001). CONCLUSIONS: The prevalence of EES is high in Korean patients with symptomatic GERD. Individual EES is more prevalent in patients with ERD than in those with NERD. QOL impairment is observed less frequently than previous studies.

Management of Asymptomatic Erosive Esophagitis: An E-Mail Survey of Physician's Opinions

BACKGROUND/AIMS: The management of asymptomatic erosive esophagitis is controversial. We surveyed physicians' opinions on asymptomatic erosive esophagitis using e-mail. METHODS: All members of the Korean Society of Neurogastro-enterology and Motility were invited to answer the questionnaire on the treatment and follow-up of patients with asymptomatic erosive esophagitis by e-mail. RESULTS: A total of 73 members answered the questionnaire (response rate, 18%). As initial management, 41% of respondents chose pharmacologic treatment, whereas 59% chose nonpharmacologic treatment. In the case of pharmacologic treatment, proton pump inhibitors were the preferred medication. The most common treatment duration was 4 weeks (43%), followed by 8 weeks (38%), and 6 months (11%). Sixty-two percent of the respondents recommended follow-up endoscopy annually, whereas 29% chose no endoscopic follow-up. Thirty-four percent of the respondents answered that they would talk about reflux-related sleep disturbances. Only 25% of the respondents explained the possibility of Barrett's esophagus or esophageal adenocarcinoma to their patients. CONCLUSIONS: There are substantial practice variations in the management of asymptomatic erosive esophagitis in Korea.

The Speed of Eating and Functional Dyspepsia in Young Women

BACKGROUND/AIMS: Little information is available on whether the speed of eating differs between individuals with and without dyspepsia, mainly because controlled studies are usually not feasible. METHODS: A survey was applied to 89 individuals with relatively controlled eating patterns, using questionnaires that assessed eating time and functional dyspepsia (FD) based on the Rome III criteria. RESULTS: The prevalence of FD was 12% (11 of 89 participants), and 7% (6 of 89) were diagnosed with gastroesophageal reflux disease (GERD). The proportion of individuals reporting that they ate their meals rapidly was higher for those with FD than for those without FD or GERD (control) (46% vs 17%, p=0.043), as was the reported eating speed (7.1+/-1.5 vs 5.8+/-2.0 [mean+/-SD], p=0.045; visual analog scale on which a higher score indicated faster eating). However, the measured eating time did not differ significantly between FD and controls (11.0+/-2.8 vs 12.8+/-3.3 minutes, p=0.098). The proportion of individuals who ate their meals within 13 minutes was significantly higher for those with FD than for controls (91% vs 51%, p=0.020). CONCLUSIONS: The results of this study suggest that eating speed affects dyspepsia. Further studies are warranted.

Vaccination Rate and Seroepidemiology of Hepatitis A in Chronic-Hepatitis-B-Infected Individuals in the Korean Army

BACKGROUND/AIMS: Vaccination against hepatitis A virus (HAV) is recommended for patients with chronic hepatitis B (CHB), since they are potentially at an increased risk of HAV-related morbidity and mortality. However, little is known about the adherence to these recommendations in the community. This study evaluated the current vaccination status and immunity against HAV among Korean military soldiers with CHB. METHODS: We performed a prospective study of Korean military soldiers from August 2008 to January 2009. We enrolled 96 soldiers with CHB on a consecutive basis. We assessed their vaccination history and the presence of anti-HAV immunoglobulin G (IgG). RESULTS: The HAV vaccination rate of the soldiers enrolled in our study was 2% (2 of the 96 soldiers). The seroprevalence rates of anti-HAV IgG among military soldiers without a vaccination history were 0%, 50%, and 100% for those aged 19-29 years (n=71), 30-39 years (n=8), and 40 years or older (n=15), respectively (p<0.001). CONCLUSIONS: The HAV vaccination rate is very low among military soldiers. Public health efforts aimed at raising awareness about HAV vaccination in patients with CHB should be strongly encouraged.

Distinguishing Xanthogranulomatous Cholecystitis from the Wall-Thickening Type of Early-Stage Gallbladder Cancer

BACKGROUND/AIMS: Xanthogranulomatous cholecystitis (XGC) mimics early-stage gallbladder (GB) cancer with wall thickening on computed tomography (CT), both clinically and radiologically. Preoperative differentiation of XGC from early-stage GB cancer is important for selecting the most appropriate surgical management. Therefore, we evaluated the clinical features and multidetector CT (MDCT) findings of XGC to determine whether it can be distinguished from early-stage GB cancer. METHODS: We retrospectively evaluated 25 patients with XGC and 56 patients with the wall-thickening type of T1- and T2-stage GB cancer, where all of the diagnoses were pathologically confirmed by surgical treatment. All of the patients underwent preoperative MDCT. The clinical symptoms, laboratory findings, and CT findings were compared. RESULTS: Abdominal pain, fever, and jaundice were noted more frequently in the patients with XGC. Serum aspartate aminotransferase and alanine aminotransferase levels were more elevated in patients with XGC, whereas carbohydrate antigen (CA 19-9) was higher in the patients with GB cancer. When the T-category cancer staging of XGC and early-stage GB cancer were compared, diffuse GB wall thickening, intramural hypoattenuated nodule, gallstone, and pericholecystic infiltration were consistent significant findings associated with XGC, regardless of the cancer staging. CONCLUSIONS: MDCT findings such as diffuse GB wall thickening, intramural hypoattenuated nodule, gallstone, and pericholecystic infiltration together with the clinical symptoms, can provide clues for physicians to differentiate XGC from early-stage GB cancer with wall thickening on CT.

The Effect of Yacon (Smallanthus sonchifolius) Extract against Dibutyltin Dichloride-induced Pancreatitis / 대한해부학회지

Yacon is used in folk medicines as a medicinal tea for hypoglycemia. In a recent study described herein, anti-oxidative, -bacterial, -fungal activities and cell protective functions of leaf extract of Smallanthus sonchifolius have been reported. In this study, to evaluate the effect on pancreatitis by using yacon extract (YE), we examined the efficacy of YE on DBTC (8 mg/kg)-induced pancreatitis in rats. After the treatment of DBTC on day 21, highly increased inflammatory cells, necrosis of acinar cells and connective tissues were observed. However, the inflammation was strongly inhibited in YE as compared to control group (CON). As a result of immunoreactions against HSP27, HSP70 and MAC387, weak or no possibilities of normal group (NOR) were observed in pancreas, whereas in immunoreactions against HSP27 and HSP70, strong expression of CON was observed in acinar and duct cells on day 14. However, the expression of HSP27 was decreased in acinar cells for CON treatment on day 21 as compared to 14 days observation, whereas strong expression of HSP27 was observed in duct cells and blood vessels on day 21. As regards the immunoreactions against HSP70, weak or no possibilities of CON were observed in duct cells and blood vessels as well as in acinar cells on day 21. In CON, time-dependent increase of MAC387 was observed. However, the expressions of HSP27 and HSP70 were weakly observed in YE as compared to CON on day 14 with strong positive reaction in acinar cells on day 21. Immunoreactions against MAC387 were decreased in YE on day 14 than day 7, which increased on day 21 as compared to day 14. These results suggested that yacon extract has inhibitory and mitigatory effects against DBTC-induced pancreatitis.

A case of symptomatic heterotopic pancreas with huge pseudocyst formation / 대한내과학회지

Heterotopic pancreas is the presence of pancreatic tissue that lacks anatomic and vascular continuity with the main body of the pancreas. Most patients with heterotopic pancreas are asymptomatic. Any pathologic change in the normal pancreas also can occur in heterotopic pancreas; namely, pancreatitis, cyst formation, hemorrhage, necrosis and neoplastic chang. But pancreatic pseudocyst formation is extremely rare in heterotopic pancreas. Recently, we experienced a case of gastric heterotopic pancreas in a 22-year-old women complicated by chronic pancreatitis with pseudocyst formation. She underwent a antrectomy with Billroth I reconstruction. Symptoms were relieved after operation. Microscopic findings were compatible with gastric heterotopic pancreas with pseudocyst formation. Herein, we report a case of symptomatic heterotopic pancreas with huge pseudocyst formation and the pertinent literatures were reviewed briefly.

Combination Chemotherapy of Oxaliplatin, 5-Fluorouracil and Low Dose Leucovorin in Patients with Advanced Colorectal Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study was to evaluate the efficacy and tolerability of the oxaliplatin, 5-fluorouracil (5-FU) and low dose leucovorin (LV) combination in patients with advanced colorectal cancer. MATERIALS AND METHODS: Patients with unresectable or recurrent colorectal carcinomas were prospectively accrued. Up to one prior chemotherapy regimen was allowed. Patients received oxaliplatin, 85 mg/m2, administered as a 2-hour infusion on day 1, followed by LV, 20 mg/m2, as a bolus and 5-FU, 1, 500 mg/m2, via continuous infusion for 24 hours on days 1 and 2. Treatment was repeated every 2 weeks until disease progression or adverse effects prohibited further therapy. RESULTS: Between August 1999 and May 2004, 31 patients were enrolled in this study. Of the patients enrolled, 24 and 31 were evaluable for tumor response and survival analysis, respectively. The patients' characteristics included a median age of 59, with 6 (19%) having had prior chemotherapy. No patient achieved a complete response, but nine (38%) attained a partial response. Seven (29%) patients maintained a stable disease and 8 (33%) experienced increasing disease. The median duration of the response was 6 months. After a median follow-up of 9.6 months, the median time to progression was 3.8 months, with a median survival of 10.7 months. The hematological toxicities were mild to moderate, with no treatment-related mortality or infection. The major non-hematological toxicity was gastrointestinal toxicity. CONCLUSIONS: The combination chemotherapy of oxaliplatin, low dose LV and continuous infusion of 5-FU is safe and has a cost-benefit, but is a moderately effective regimen in advanced colorectal cancer. A randomized trial comparing low and high dosages of leucovorin in the FOLFOX regimen is warranted.

Clinical Manifestations of Acute Renal Failure with Loin Pain Developed after the Anaerobic Exercise / 대한신장학회잡지

BACKGROUND: Rhabdomyolysis is a well known cause of the exercise induced acute renal failure (ARF), but the patch renal vasoconstriction with severe loin pain which developed after the anaerobic exercise is not. Although there are a few cases about ARF resulted from the patchy renal vasoconstriction in Korea, there are only a few reports about comparisons of their clinical manifestations. METHODS: Eight patients of ARF with severe loin pain after the exercise, were admitted to Chungbuk national university hospital from April 1994 to March 2004. For all patients, we obtained basic clinical findings and laboratory studies, and performed an enhanced computed tomography (CT) initially and delayed CT without contrast media at least 6 hours after. RESULTS: All the patients were previously healthy young men. The main symptom was loin pain in five patients and all patients experienced the anaerobic exercise before. Six patients took analgesics and fever was observed in seven patients. There was no marked elevation of creatinine phosphokinase (CPK). The initial mean creatinine (Cr) was 3.50+/-1.49 mg/dL and the maximum Cr was 8.8 mg/dL. All the patients fully recovered their renal function. We observed the typical patchy wedge-shaped contrast enhancement CT findings in seven patients. CONCLUSION: Differential diagnosis between rhabdomyolysis and the patchy renal vasoconstriction in newly developed ARF after exercise is important. Our eight patients showed typical clinical manifestations. In cases which implicate the pathy renal vasoconstriction by their typical clinical findings, the enhanced CT and the delayed postcontrast CT are helpful for diagnosis.

Changes in Flow-Mediated Vasodilation after a Single Session of Hemodialysis / 대한신장학회잡지

BACKGROUND: The cardiovascular morbidity and mortality are much higher in the patients who undergo hemodialysis than normal population. Atherosclerotic vascular disease is one of the most important causes of cardiovascular disease, and it is thought to be related to endothelial function. It is known that endothelial function in the end-stage renal disease (ESRD) patients is decreased, but it is not clear the hemodialysis can improve the endothelial function or not. Hemodialysis can remove uremic toxins and improve endothelial function, but it also can cause oxidative stress to vascular endothelial cell. The purpose of this study is to determine whether hemodialysis could improve endothelial function compared with simple ultrafiltration in the same patient. METHODS: We prospectively evaluated endothelial function of hemodialysis patients by flow-mediated vasodilation (FMD) method in the patient's right brachial artery. Total thirteen patients were enrolled in this study, and their right brachial artery diameters were measured by 7 MHz echocardiography probe, and calculated by enlarged scan image. FMD were measured before and after hemodialysis, and measured before and after simple ultrafiltration in the same patient, same four hours of each session. RESULTS: The mean brachial artery diameters were 4.18+/-1.11 mm in pre-hemodialysis and 4.25+/-1.15 mm in pre-ultrafiltration respectively, and there was no statistic difference. Average percent change of brachial artery diameter before and after hemodialysis were 2.20+/-1.67 and 1.35+/-1.22% (p<0.05). The same of ultrafiltration were 2.13+/-1.99 and 2.72+/-1.79% (p=0.431). CONCLUSION: In summary, flow mediated vasodilation after a single session of hemodialysis, in contrast with simple ultrafiltration, could be diminished significantly.

A Case of Esophageal Obstruction after Cyanoacrylate Injection Sclerotherapy / 대한소화기내시경학회지

Cyanoacrylate is well recognized for its effect in the treatment of the gastric variceal bleeding rather than the esopahgeal variceal bleeding. We used endoscopic injection sclerotherapy (EIS) with cyanoacrylate for the control of esophageal variceal bleeding in which endoscopic variceal ligation (EVL) was difficult due to severe post-EVL scar changes of the esophageal mucosa. The hemostasis by EIS with cyanoacrylate was successfully achieved despite the massive bleeding. However, esophageal obstruction occurred after the EIS treatment. Later, the obstruction resolved spontaneously as the polymer was expelled into the esophageal lumen. We report this case with a brief review of the literatures.

A Case of Paraquat Intoxication Caused by Intramuscular Injection / 대한신장학회잡지

Paraquat intoxication is a fatal problem. Most of paraquat intoxications happen through oral administration. But there is no clinical data for parenteral paraquat intoxication, so we will describe its fatal progression and clinical course. A 52-year-old male injected paraquat solution on his thigh. Initial serum level of paraquat was 42.7 microgram/mL and urgent hemoperfusion was performed and his serum level of paraquat was reduced by 5.2 microgram/mL. But the patient expired due to respiratory failure and hypoxemia. Different from oral paraquat poisoning, serum level of the drug increases rapidly in intramuscular intoxication. So the paraquat in blood rapidly accumulates in tissue, especially lung parenchyme. We removed his paraquat in blood rapidly, but could not get rid of tissue concentration, so we lost him even with lowered serum paraquat level. Through this case, it is thought that the paraquat intoxication via intramuscular injection can make up a extremely poor prognosis even with very a little amount of paraquat.