A Case of Sigmoid Intussusception Diagnosed by Sigmoidoscopy / 대한소화기내시경학회지

Intussusception most commonly occurs in children, and in more than 90% of cases, no cause is found. In contrast, intussusception in adults is relatively rare but over 90% of patients have an organic lesion as the cause. Only 5% of cases of intussusception occur in adults and most involve the small intestine and are benign, whereas colonic intussusceptions are usually malignant. We report here a case of a 70-year-old man with intussusception who was referred with a one-day history of hematochezia and abdominal pain. The intussusception was caused by a sigmoid colonic tumor. The CT findings suggested that we could reasonably proceed to a sigmoidoscopy to confirm the site of obstruction. We speculated that the sigmoid colon tumor induced the anterograde intussusception. As with our patient, it is important to recognize the need to diagnose the primary lesion exactly and promptly.

Clinicopathlogic characteristics of multiple synchronous early gastric cancers / 대한내과학회지

BACKGROUND: With the progress of limited surgery and endoscopic treatment for early gastric cancer (EGC), multiple synchronous EGCs, a cause of recurrence, become more important. The objective of this study was to elucidate the characteristics of multiple synchronous EGCs with an emphasis on features of preoperatively undiagnosed lesions. METHODS: We retrospectively reviewed medical records of 496 patients who underwent a gastrectomy for EGC at our institution between January 2004 and December 2004. RESULTS: Twenty-four patients (4.8%) had multiple synchronous EGCs with 24 main and 27 accessory lesions. Multiple synchronous EGCs showed male predominance (p=0.03). Other characteristics including lymph node metastasis were the same as with single EGC. Out of 27 accessory lesions, six lesions (22%) were not detected preoperatively in six patients (25%). Macroscopically five lesions were flat and one lesion was depressed. Five lesions were located at the anterior or posterior wall of the middle and low third portion and one lesion was located at the lesser curvature side of the upper third portion of the stomach. Two lesions were 4 mm, one lesion was 8 mm, two lesions were 12 mm and one lesion was 15 mm in size (mean diameter = 9.1 mm). Histologically, four lesions were of the differentiated type and two lesions were of the undifferentiated type. CONCLUSIONS: Multiple synchronous EGCs have same clinicopathologic features as a single EGC except for male predominance. Considering the possibility of a synchronous lesion, one should examine the entire stomach precisely with special attention to the anterior, posterior wall and lesser curvature side of the same or neighboring area of a known EGC lesion before treatment.

A Case of Autoimmune Pancreatitis Diagnosed by Immunohistochemical Staining of IgG4 / 대한소화기내시경학회지

Autoimmune pancreatitis is a distinct entity with characteristic morphological, histological and clinical features. Since the first report in 1961, there have been many reports on autoantibodies associated with autoimmune pancreatitis. Lymphoplasmacytic infiltration with fibrosis is the characteristic histological feature of autoimmune pancreatitis. Elevation of immunoglobulin G4 (IgG4), a subtype of IgG, can be seen in autoimmune pancreatitis. A few reports of autoimmune pancreatitis based on immunostaining of IgG4 have been published, but no reports have been published in Korea. We present here the first report of autoimmune pancreatitis, based on an increased serum IgG4 level and plasma cell infiltration that showed IgG4 positivity by immunohistochemical staining of the major papilla.

A Case of Eneropathy-associated T-cell Lymphoma Presenting with Persistent Abdominal Pain and Diarrhea / 대한소화기내시경학회지

Enteropathy-associated T-cell lymphoma (EATL) is an unusual primary gastrointestinal lymphoma, and it is particularly associated with celiac sprue. These patients typically suffer from abdominal pain, diarrhea and/or weight loss. Primary intestinal T-cell lymphoma without celiac sprue is known to be rare. We report here on a case of EATL that presented with persistent abdominal pain and diarrhea, but this patient was without celiac sprue.

A Case of Eneropathy-associated T-cell Lymphoma Presenting with Persistent Abdominal Pain and Diarrhea / 대한소화기내시경학회지

Enteropathy-associated T-cell lymphoma (EATL) is an unusual primary gastrointestinal lymphoma, and it is particularly associated with celiac sprue. These patients typically suffer from abdominal pain, diarrhea and/or weight loss. Primary intestinal T-cell lymphoma without celiac sprue is known to be rare. We report here on a case of EATL that presented with persistent abdominal pain and diarrhea, but this patient was without celiac sprue.

An Evaluation of Web-based Informations about Gastroesophageal Reflux Diseases in Korea / 대한소화기학회지

BACKGROUND/AIMS: Internet has become an important source of medical information not only for medical personnels but also for patients. The aim of this study was to evaluate the quality of internet based medical information about 'gastroesophageal reflux' or 'reflux esophagitis' in Korea. METHODS: The first 15 internet sites using the key words 'gastroesophageal reflux' or 'reflux esophagitis' were retrieved from the 7 most frequently used internet search engines. The quality of information from a total of 108 websites was evaluated using a checklist. RESULTS: Among total 108 sites related to 'gastroesophageal reflux' or 'reflux esophagitis', fifty-six sites (51.8%) were made by hospitals or clinics and 94 sites (87.0%) were made for patients. Of the 108 sites, eleven web sites (10.1%) had more than three JAMA benchmarks (authorship, references, currency, and disclosure). Higher quality sites (at least three JAMA benchmarks) were less likely to contain inaccurate information than lower quality sites (fewer than three JAMA benchmarks)-3/11 (27.2%) vs. 60/97 (61.9%) (p<0.01). Despite the fact that articles in the literature emphasized an insufficient evidence to support an association between the lifestyle, dietary behaviors, and GERD, such guidelines continue to be recommended as first-line therapy in most websites. CONCLUSIONS: Informations about gastroesophageal reflux disease were incomplete in the majority of medical web sites. These would bring about confusion to patients seeking for an information about GERD through the internet. There is a need for better sources in evidence based informations about gastroesophaeal reflux diseases on the web.

Comparative Usefulness of Erythrocyte Sedimentation Rate and C-reactive Protein in Assessing the Severity of Ulcerative Colitis / 대한소화기학회지

BACKGROUND/AIMS: Although erythrocyte sedimentation rate (ESR) is included as a laboratory parameter in Truelove and Witts' classification, C-reactive protein (CRP) is also used for severity assessment in ulcerative colitis (UC). Frequently, the discordance between ESR and CRP is observed in clinical practice. The aim of this study was to determine which parameter is more related with clinical activity in UC patients. METHODS: A total of 155 patients with UC were identified from January 2004 to March 2005. Their medical records were reviewed within these patients, a total of 541 assessments of disease activity were made. Correlation of clinical activity and laboratory tests were evaluated by Pearson's correlation coefficient. RESULTS: Pearson's correlation coefficients of ESR and CRP with clinical symptoms were 0.376 and 0.258, respectively. The correlation coefficient between ESR and CRP was 0.403 (p=0.000). A total of 131 (24.2%) assessments revealed discordance between ESR and CRP. When discordance occurred, the correlation coefficients with clinical symptoms were 0.338 for ESR (p=0.000) and 0.034 for CRP (p>0.01). Dividing discordant patients into high ESR/low CRP group and low ESR/high CRP group, the coefficients were 0.420 for ESR and 0.226 for CRP in high ESR/low CRP group, and 0.333 for ESR and 0.068 for CRP in low ESR/high CRP group. CONCLUSIONS: The correlation analysis indicates that ESR appears to be a more reliable laboratory parameter of disease activity than CRP in assessing the severity of UC. In particular, when the level of ESR and CRP is discordant, ESR is more useful in assessing the disease activity in UC patients.